Computed tomography scans of alcoholics: cerebral atrophy?

Longitudinal changes in magnetic resonance imaging brain volumes in abstinent and relapsed alcoholics

Chronic alcoholism is associated with smaller volumes of cortical gray matter and white matter and a complementary increase in brain cerebrospinal fluid (CSF) volumes, relative to age norms. This longitudinal study quantified the extent of brain volume changes associated with abstinence and drinking at three time points in chronic alcoholics. We obtained magnetic resonance imaging (MRI) on 58 alcoholic men after an average of 12 days (MRI-1) and 32 days (MRI-2) of sobriety. In addition, 58 healthy control subjects were scanned at a comparable interval. At MRI-3, 11 controls and 39 alcoholics were rescanned, 2-12 months after MRI-2; 19 alcoholics had abstained, and 20 had resumed drinking. Axial MRI slices were segmented into cortical gray matter, white matter, and CSF and summed over seven slices; lateral and third ventricular volumes were also estimated. MRI volume changes were corrected using an estimate of interscan measurement error caused by head positioning differences, and then divided by the interval to yield rates of change (slopes). From MRI-1 to MRI-2, the alcoholic group showed declines in CSF volumes of the lateral ventricles and posterior cortical sulci, and a trend toward an increase in anterior cortical gray matter volume relative to the control group. From MRI-2 to MRI-3, third ventricular volumes decreased in the abstainers relative to the relapsers and controls; cortical white matter volume decreased in the relapsers. In the relapsers, lifetime consumption of alcohol (as of MRI-1) predicted later vulnerability to white matter volume decline and third ventricular enlargement with resumption of drinking. These data suggest that improvement in cortical gray matter, sulcal, and lateral ventricular volumes occur early in the course of abstinence, and that improvement in third ventricular volume appears later with continued abstinence.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholic dementia

At least four distinct cerebral diseases--Wernicke-Korsakoff, Marchiafava-Bignami, pellagrous encephalopathy, and acquired hepatocerebral degeneration--have a close association with chronic alcoholism. Each is characterized by a distinctive pathologic change and a reasonably well-established pathogenesis; in each the role of alcohol in the causation is secondary. The question posed in this review is whether there is, in addition to the established types of dementia associated with alcoholism, a persistent dementia attributable to the direct toxic effects of alcohol on the brain--i.e., a primary alcoholic dementia. The clinical, psychologic, radiologic, and pathologic evidence bearing on this question is critically reviewed. None of the evidence permits the clear delineation of such an entity. The most serious flaw in the argument for a primary alcoholic dementia is that it lacks a distinctive, well-defined pathology, and it must remain ambiguous until such time as its morphologic basis is established.

MRI study of brain changes with short-term abstinence from alcohol

Magnetic resonance brain scans were obtained from 10 chronic alcoholics within 2 weeks of alcohol withdrawal, and 19 to 28 days later. Age-matched control subjects were scanned at comparable intervals. At the initial scan, the alcoholics had larger lateral ventricles than the controls; at the second scan, their ventricles were significantly smaller than at the first scan. Among the controls, there was no mean change in the size of the lateral ventricles between the first and second scan. This study demonstrates reversibility in ventricular enlargement with short-term abstinence from alcohol. The role of rehydration in this process and the possibility of further changes with continued abstinence remain to be tested.

Computerized tomographic scan assessment of alcoholic brain damage and its potential reversibility

The assessment of alcoholic brain damage by computerized tomographic (CT) scanning is reviewed and discussed. Alcoholics showed greater cerebral atrophy than aged-matched neurological controls. Supratentorial atrophy measurements correlated significantly with some neurobehavioral assessment measures. The cerebral atrophy reversed in some subjects with maintained abstinence. Computerized assessment of cerebral spinal fluid volume (cerebral atrophy) and mean cerebral density showed decreased cerebral spinal fluid volume and increased cerebral density with maintained abstinence over 4 weeks in a group of 20 alcoholics. CT cerebellar measurements demonstrated atrophy in many subjects, but these measurements did not correlate with measures of ataxia, cognitive impairment, supratentorial atrophy measurements, or age. An example of a magnetic resonance imaging scan of an alcoholic is given. Its advantages in avoiding bony artifact for posterior fossa atrophy estimations and its potential for in vivo description and localization of central nervous system metabolic abnormalities in alcoholism are discussed.

Abstinence improves cerebral perfusion and brain volume in alcoholic neurotoxicity without Wernicke-Korsakoff syndrome

Twenty severe chronic alcoholic patients with signs of neurotoxicity but without Wernicke-Korsakoff syndrome were treated by abstinence from alcohol and examined prospectively at intervals thereafter. Serial examinations included detailed medical histories, neurological examinations, cognitive capacity screening examinations, computed tomography scans with measurements of sulcal and ventricular volume, and measurements of regional CBF. All sedatives were withdrawn before CBF measurements were made. Before treatment, gray matter blood flow values were significantly reduced compared with those of age-matched normal volunteers, but white matter blood flow values were normal and the ventricles were enlarged. After abstinence from alcohol, mean gray matter blood flow values and brain volume both increased significantly.

Guide to CAT scanning in hospital psychiatry. Overview of clinical practice and criteria for use

Advances in imaging techniques have resulted in increasing use of computed axial tomography (CAT) in clinical psychiatry. Treatable brain lesions predominantly manifesting as emotional and behavioral symptoms can be detected with relative ease and safety by CAT scanning. Criteria to select these high-risk psychiatric patients for CAT exam are vague and sparse compared to more abundant guidelines for scanning neurologic and medical patients with focal signs of physical abnormality. The few existing surveys of inpatient psychiatry CAT scanning reveal a 65-70% range of normal findings. As more and more patients are scanned, such an obviously large group of "normals" should not be exposed to current CAT exam costs and risks; at the same time, it is necessary to ensure that those psychiatric patients warranting the procedure are not neglected in referral. This article highlights clinical aspects of CAT brain imaging, summarizes the existing literature on inpatient psychiatry CAT scanning, and recommends initial criteria for CAT brain examination of hospitalized patients.

Alcoholic brain damage and neurological symptoms of alcohol withdrawal--manifestations of overhydration

Central nervous system damage is a major complication of alcohol abuse. Vitamin deficiency, particularly thiamine deficiency, has a role in producing pathological and psychological changes of alcoholic brain damage, but it is likely that alcohol has a direct toxic effect on the brain. It is proposed that neuropathological abnormalities seen in alcoholics, and also neurological symptoms during alcohol withdrawal, may reflect cerebral edema caused by alcohol. The neurological symptoms of alcohol withdrawal show a similarity to those seen in hyponatremia or water intoxication. It is suggested that alcoholics show overhydration particularly during withdrawal and that pathological changes in the alcoholic brain are related to cerebral edema. Cerebral edema in withdrawing alcoholics may be caused by inappropriate section of vasopressin (antidiuretic hormone).

Examination of alcoholics by computed tomographic (CT) scans: a critical review

Neuroradiological studies have consistently demonstrated that alcoholics have morphological abnormalities of cortical, ventricular, and cerebellar structures suggesting brain atrophy. This atrophy is weakly correlated with impaired psychological test performance. Because brain atrophy and intellectual impairment can also be found in normal aging it is necessary to compare alcoholics with age-matched control subjects. It is currently unknown if alcohol-associated brain atrophy and intellectual impairment are the result of conditions preceding alcohol consumption or conditions only indirectly related such as head trauma or other associated diseases. Direct alcohol toxicity would be supported by quantitative alcohol-atrophy dose-response relationships and by a partial reversal of atrophy and functional impairment following abstinence from alcohol. Because of methodological difficulties inherent in neuroradiological research, data on the exact pathogenesis of abnormalities in alcoholics have not been produced. The design of such studies can be improved to increase the probability that the causes of brain atrophy will be elucidated.