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Wang Y, Zha H. Neuroimaging for differential diagnosis of transient neurological attacks. Brain Behav 2022; 12:e2780. [PMID: 36350080 PMCID: PMC9759151 DOI: 10.1002/brb3.2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Rapid yet comprehensive neuroimaging protocols are required for patients with suspected acute stroke. However, stroke mimics can account for approximately one in five clinically diagnosed acute ischemic strokes and the rate of thrombolyzed mimics can be as high as 17%. Therefore, to accurately determine the diagnosis and differentiate mimics from true transient ischemic attacks, acute ischemic stroke is a challenge to every clinician. DISCUSSION Medical history and neurological examination, noncontract head computed tomography, and routine magnetic resonance imaging play important roles in the assessment and management of patients with transient neurological attacks in the emergency department. This review attempts to summarize how neuroimaging can be utilized to help differentiate the most common mimics from transient ischemic attack and acute ischemic stroke. CONCLUSION Although imaging can help direct critical triage decisions for intravenous thrombolysis or endovascular therapy, more detailed medical history and neurological examination are crucial for making a prompt and accurate diagnosis for transient neurological attack patients.
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Affiliation(s)
- Ying Wang
- Department of Neurology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hao Zha
- Department of Reproductive and Genetics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Brust JC. Stroke and Substance Abuse. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Joe GW, Lehman WEK, Rowan GA, Knight K, Flynn PM. The role of physical and psychological health problems in the drug use treatment process. J Subst Abuse Treat 2019; 102:23-32. [PMID: 31202285 DOI: 10.1016/j.jsat.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/28/2022]
Abstract
The role of physical and psychological health is examined as a predictor of client engagement in prison-based drug treatment. A treatment process model was expanded to include physical and mental health issues. The sample included 6009 offenders in prison-based drug treatment, comprised of 67% male, 26% African American, 51% white, and 22% Hispanic; average age was 34.6. Half reported "some physical health concerns" and mentioned a variety of ailments. A fifth reported moderate stress on the Kessler Psychological Distress Scale (K10) and 15% reported PTSD based on the PTSD Check List (PCL). Structural equation modeling was used to model treatment engagement in terms of demographics, physical health concerns, psychological distress, HIV risky behaviors, self-esteem, decision making, and treatment motivation. Two random samples were created, with one used for estimation and the other for cross-validation. The findings suggested physical health and HIV risky behaviors have effects on client engagement through psychological functioning, and that psychological functioning has direct effects on treatment engagement.
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Affiliation(s)
- George W Joe
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Wayne E K Lehman
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Grace A Rowan
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Kevin Knight
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
| | - Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
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McCann UD, Lowe KA, Ricaurte GA. REVIEW ■ : Long-lasting Effects of Recreational Drugs of Abuse on the Central Nervous System. Neuroscientist 2016. [DOI: 10.1177/107385849700300613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although a wealth of knowledge exists regarding the acute pharmacological effects of recreational drugs on the CNS, much less is known about the long-term toxic effects of recreational drugs on the CNS. Recent findings in nonhuman primates treated with amphetamine analogs, such as ±3,4-methylenedioxymetham phetamine (MDMA), indicate that these drugs can produce long-lasting, probably permanent, changes in brain serotonin innervation. Similarly, animals treated with phencyclidine (PCP) and related drugs develop neurodegenerative changes in selected brain regions. It seems clear, then, that some psychoactive drugs have the potential to produce persistent changes in CNS structure and, possibly, function. The goal of this article is to summarize current knowledge regarding the long-term effects of several popular recreational drugs, including MDMA and related amphetamine analogs, cocaine, marijuana, alcohol, PCP, lysergic acid (LSD), and opiates. Gaps in the current knowledge base are identified, and areas ripe for future research efforts are suggested. NEUROSCIENTIST 3:399-411, 1997
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Affiliation(s)
- Una D. McCann
- Biological Psychiatry Branch NIMH-IRP Bethesda, Maryland
| | - Kelly A. Lowe
- Department of Neurology Johns Hopkins Medical Institutions
Baltimore, Maryland
| | - George A. Ricaurte
- Department of Neurology Johns Hopkins Medical Institutions
Baltimore, Maryland
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Norman LR, Basso M. An Update of the Review of Neuropsychological Consequences of HIV and Substance Abuse: A Literature Review and Implications for Treatment and Future Research. ACTA ACUST UNITED AC 2016; 8:50-71. [PMID: 25751583 DOI: 10.2174/1874473708666150309124820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 12/14/2022]
Abstract
Neuropyschological dysfunction, ranging from mild cerebral indicators to dementia has been a consistent part of the medical picture of HIV/AIDS. However, advances in medical supervision, particularly as a result of antiretroviral (ARV) treatment, have resulted in some mitigation of the neuropsychological effects of HIV and necessitate re-evaluation of the pattern and nature of HIV-related cognitive or mental deficits. The associated enhancements in morbidity and mortality that have occurred as a result of ARV medication have led to a need for interventions and programs that maintain behaviors that are healthy and stop the resurgence of the risk of HIV transmission. Risk factors such as mental illness and substance use that may have contributed to the initial infection with HIV still need consideration. These risk factors may also increase neuropsychological dysfunction and impact observance of prevention for treatment and recommendations. Explicitly, a better comprehension of the role of substance use on the progression of HIV-related mental decline can enlighten management and evaluation of persons living with HIV with concurrent disorders of substance use. This review provides a summary of the neurophyschology of substance use and HIV and the existing research that has looked at the effects of both substance use and HIV disease on neurophyscological function and suggestions for future research and treatment.
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Affiliation(s)
- Lisa R Norman
- Public Health Program, Ponce School of Medicine, Ponce, PR 00732, USA.
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Calcaterra SL, Keniston A, Blum J, Crume T, Binswanger IA. The Association Between Stimulant, Opioid, and Multiple Drug Use on Behavioral Health Care Utilization in a Safety-Net Health System. Subst Abus 2015; 36:407-12. [PMID: 25738222 DOI: 10.1080/08897077.2014.996697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Prior studies show an association between drug use and health care utilization. The relationship between specific drug type and emergent/urgent, inpatient, outpatient, and behavioral health care utilization has not been examined. We aimed to determine if multiple drug use was associated with increased utilization of behavioral health care. METHODS To assess health care utilization, we conducted a retrospective cohort study of patients who accessed health care at a safety-net medical center and affiliated clinics. Using electronic health records, we categorized patients who used stimulants, opioids, or multiple drugs based on urine toxicology screening tests and/or International Classification of Diseases, 9th Revision (ICD-9). Remaining patients were categorized as patients without identified drug use. Health care utilization by drug use group and visit type was determined using a negative binomial regression model. Associations were reported as incidence rate ratios. Utilization was described by rates of health care-related visits for inpatient, emergent/urgent, outpatient, and behavioral health care among patients who used drugs, categorized by drug types, compared with patients without identified drug use. RESULTS Of 95,198 index visits, 4.6% (n=4340) were by patients who used drugs. Opioid and multiple drug users had significantly higher rates of behavioral health care visits than patients without identified drug use (opioid incidence rate ratio [IRR]=7.2; 95% confidence interval [CI]: 3.8-13.8; multiple drug use IRR=5.6, 95% CI: 3.3-9.7). Patients who used stimulants were less likely to use behavioral health services (IRR=1.3, 95% CI: 0.9-2.0) when compared with opioid and multiple drug users, but were more likely to use inpatient (IRR=1.6, 95% CI: 1.4-1.8) and emergent/urgent care (IRR=1.4, 95% CI: 1.3-1.5) services as compared with patients without identified drug use. CONCLUSIONS Integrated medical and mental health care and drug treatment may reduce utilization of costly health care services and improve patient outcomes. How to capture and deliver primary care and behavioral health care to patients who use stimulants needs further investigation.
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Affiliation(s)
- Susan L Calcaterra
- a Division of General Internal Medicine, Department of Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.,b Department of Medicine , Denver Health Medical Center , Denver , Colorado , USA
| | - Angela Keniston
- b Department of Medicine , Denver Health Medical Center , Denver , Colorado , USA
| | - Joshua Blum
- a Division of General Internal Medicine, Department of Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.,b Department of Medicine , Denver Health Medical Center , Denver , Colorado , USA
| | - Tessa Crume
- c Department of Epidemiology, Colorado School of Public Health , University of Colorado School of Medicine , Aurora , Colorado , USA
| | - Ingrid A Binswanger
- a Division of General Internal Medicine, Department of Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.,b Department of Medicine , Denver Health Medical Center , Denver , Colorado , USA.,d Institute for Health Research, Kaiser Permanente Colorado , Denver , Colorado , USA
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Carreiro S, Blum J, Hack JB. Pretreatment With Intravenous Lipid Emulsion Reduces Mortality From Cocaine Toxicity in a Rat Model. Ann Emerg Med 2014; 64:32-7. [DOI: 10.1016/j.annemergmed.2013.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 11/11/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
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Cadet JL, Bisagno V, Milroy CM. Neuropathology of substance use disorders. Acta Neuropathol 2014; 127:91-107. [PMID: 24292887 PMCID: PMC7453825 DOI: 10.1007/s00401-013-1221-7] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/20/2013] [Indexed: 01/23/2023]
Abstract
Addictions to licit and illicit drugs are chronic relapsing brain disorders that affect circuits that regulate reward, motivation, memory, and decision-making. Drug-induced pathological changes in these brain regions are associated with characteristic enduring behaviors that continue despite adverse biopsychosocial consequences. Repeated exposure to these substances leads to egocentric behaviors that focus on obtaining the drug by any means and on taking the drug under adverse psychosocial and medical conditions. Addiction also includes craving for the substances and, in some cases, involvement in risky behaviors that can cause death. These patterns of behaviors are associated with specific cognitive disturbances and neuroimaging evidence for brain dysfunctions in a diverse population of drug addicts. Postmortem studies have also revealed significant biochemical and/or structural abnormalities in some addicted individuals. The present review provides a summary of the evidence that has accumulated over the past few years to implicate brain dysfunctions in the varied manifestations of drug addiction. We thus review data on cerebrovascular alterations, brain structural abnormalities, and postmortem studies of patients who abuse cannabis, cocaine, amphetamines, heroin, and "bath salts". We also discuss potential molecular, biochemical, and cellular bases for the varied clinical presentations of these patients. Elucidation of the biological bases of addiction will help to develop better therapeutic approaches to these patient populations.
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Affiliation(s)
- Jean Lud Cadet
- NIDA Intramural Research Program, Molecular Neuropsychiatry Research Branch, NIDA/NIH/DHHS, 251 Bayview Boulevard, Baltimore, MD, 21224, USA,
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de los Ríos la Rosa F, Kleindorfer DO, Khoury J, Broderick JP, Moomaw CJ, Adeoye O, Flaherty ML, Khatri P, Woo D, Alwell K, Eilerman J, Ferioli S, Kissela BM. Trends in substance abuse preceding stroke among young adults: a population-based study. Stroke 2012; 43:3179-83. [PMID: 23160887 PMCID: PMC3742309 DOI: 10.1161/strokeaha.112.667808] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Approximately 5% of strokes occur in adults aged 18 to 44 years. Substance abuse is a prevalent risk factor for stroke in young adults. We sought to identify trends in substance abuse detection among stroke patients. METHODS Using a population-based design, we sought to identify all patients aged 18 to 54 years experiencing a stroke (ischemic or hemorrhagic) in the Greater Cincinnati and Northern Kentucky Study region during 1993 to 1994, 1999, and 2005. Demographic and clinical characteristics and substance use data were obtained retrospectively from chart review and adjudicated by physicians. RESULTS The number of young patients identified with a stroke increased from 1993 to 1994 (297) to 2005 (501). Blacks (61% vs 51%; P<0.02) and men (61% vs 47%; P<0.002) reported substance abuse (current smoking, alcohol, or illegal drug use) more frequently than did whites and women. Overall use of substances increased across study periods, 45% in 1993 versus 62% in 2005 (P=0.003). The trend was significant for illegal drug use (3.8% in 1993 vs 19.8% in 2005) and ever smoking (49% in 1993 vs 66% in 2005). Documentation of both cocaine and marijuana use increased over time. In 2005, half of young adults with a stroke were current smokers, and 1 in 5 abused illegal drugs. CONCLUSIONS Substance abuse is common in young adults experiencing a stroke. The observed increase in substance abuse is contributing to the increased incidence of stroke in young adults. Patients aged younger than 55 years who experience a stroke should be routinely screened and counseled regarding substance abuse.
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Affiliation(s)
| | - Dawn O. Kleindorfer
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Joseph P. Broderick
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Opeolu Adeoye
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew L. Flaherty
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel Woo
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Jane Eilerman
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Simona Ferioli
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brett M. Kissela
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Shvartsbeyn M, Phillips DGK, Markey MA, Morrison A, DeJong JL, Castellani RJ. Cocaine-induced intracerebral hemorrhage in a patient with cerebral amyloid angiopathy. J Forensic Sci 2011; 55:1389-92. [PMID: 20456585 DOI: 10.1111/j.1556-4029.2010.01410.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intracerebral hemorrhage (ICH) is a well-recognized complication of recreational cocaine use. The precise mechanism of the cocaine-induced hemorrhagic event is unclear, although multiple factors have been implicated. We report a case of a 62-year-old woman who suffered left parieto-occipital ICH with herniation and death, following a cocaine binge. Microscopic examination also revealed extensive cerebral amyloid angiopathy (CAA) in the vicinity of the hemorrhage. We additionally studied brain tissue in eight subjects between ages of 60 and 80 who were positive for cocaine metabolites at autopsy; of these, none had vascular amyloid-β deposits by immunohistochemistry. Whereas we found no evidence that chronic cocaine use is a risk factor for CAA, given the age-associated nature of CAA and the aging population using cocaine, CAA-induced hemorrhage in the setting of cocaine use may be more common than recognized. This is the first reported case of CAA-associated ICH precipitated by cocaine.
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Affiliation(s)
- Marianna Shvartsbeyn
- Department of Pathology, New York University School of Medicine, New York, NY, USA
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12
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13
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Stroke and Substance Abuse. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Neurovascular complications of cocaine use at a tertiary stroke center. J Stroke Cerebrovasc Dis 2010; 19:273-8. [PMID: 20444626 DOI: 10.1016/j.jstrokecerebrovasdis.2009.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 05/05/2009] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE An association between cocaine use and stroke has been reported, but few studies have examined cocaine-related neurovascular disease using modern stroke diagnostic techniques. We describe a large cohort of patients with cocaine-related stroke to define the pathophysiology and manifestations of cocaine-related neurovascular disease. METHODS All adult admissions to a tertiary neurovascular service from July 1, 1998 to July 1, 2008 were screened for evidence of current or previous cocaine use. Patients included underwent thorough review of medical records including diagnostic procedure, laboratory, and imaging results. RESULTS A total of 5,142 records were screened and 96 patients were identified; 45 (47%) were given the diagnosis of ischemic stroke/transient ischemic attack (TIA), 26 (27%) with intracerebral hemorrhage (ICH), and 25 (26%) with subarachnoid hemorrhage. In all, 61 (63.5%) patients were categorized as active and 35 (36.5%) as previous cocaine users. Stroke type differed significantly between active and prior users (P=.004), with active users more likely to have ICH compared with previous users (37.7% v 8.6%) and less likely to have ischemic stroke or TIA (36.1% v 65.7%). The most common stroke/TIA cause was large artery atherosclerosis in 20 (44%) patients. Of the 25 subarachnoid hemorrhage cases, 22 (88%) were aneurysmal. CONCLUSION Ischemic stroke/TIA is a common neurovascular presentation in patients with a remote history of cocaine use, often as a result of atherosclerotic disease; neither vasculitis nor vasospasm was a common cause of stroke in this cohort. ICH is more common in those currently using cocaine perhaps because of acute spikes in blood pressure. Further prospective trials are needed to confirm these results.
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Provenzale JM, Hacein-Bey L. CT evaluation of subarachnoid hemorrhage: a practical review for the radiologist interpreting emergency room studies. Emerg Radiol 2009; 16:441-51. [DOI: 10.1007/s10140-009-0824-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 06/02/2009] [Indexed: 11/28/2022]
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17
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Thöne-Otto AI. Psychotherapie bei Alzheimerpatienten: Eine neuropsychologische Aufgabe. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2009. [DOI: 10.1024/1016-264x.20.1.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Kognitive, emotionale und behaviorale Veränderungen sind bei kaum einer Krankheit so sehr verwoben wie bei der Alzheimererkrankung. Dies ist auf die anfänglich zwar akzentuierten im weiteren Verlauf jedoch ubiquitäre Neurodegeneration zurückzuführen. In dieser Komplexität fällt die psychotherapeutische Behandlung von Alzheimerpatienten in die Kernkompetenz der Neuropsychologie. Am Beispiel der Therapie von Anosognosie, Apathie / Depression und Amnesie wird erläutert, wie eine integrative Behandlung, also die gleichzeitige Berücksichtigung affektiver und kognitiver Einflussfaktoren sowie der Einbezug der Angehörigen realisiert werden kann. Es werden Entscheidungshilfen für den Umgang mit verschiedenen Schweregraden der Anosognosie vermittelt. Aktivitätsaufbau wird als zentrale Möglichkeit im Umgang mit Depression und Apathie vorgestellt. Schließlich werden Methoden zur Vermittlung von domänenspezifischem Wissen und die zentrale Ressource des weitgehend erhaltenen prozeduralen Gedächtnisses in der Kompensation von deklarativen Gedächtnisstörungen beschrieben. Biografiearbeit wird als Chance im Umgang mit einem zunehmenden Identitätsverlust aufgrund episodischer Altgedächtnisstörungen vorgestellt. Die Neuropsychologische Therapie der Alzheimererkrankung steht noch am Beginn. Sie wird erfolgreich sein, wenn es gelingt, die verschiedenen Dimensionen der Erkrankung zu integrieren.
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Sharma HS, Muresanu D, Sharma A, Patnaik R. Cocaine-induced breakdown of the blood-brain barrier and neurotoxicity. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 88:297-334. [PMID: 19897082 DOI: 10.1016/s0074-7742(09)88011-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Role of cocaine in influencing blood-brain barrier (BBB) function is still unknown. Available evidences suggest that cocaine administration results in acute hyperthermia and alterations in brain serotonin metabolism. Since hyperthermia is capable to induce the breakdown of the BBB either directly or through altered serotonin metabolism, a possibility exists that cocaine may induce neurotoxicity by causing BBB disruption. This hypothesis is discussed in this review largely based on our own laboratory investigations. Our observations in rats demonstrate that cocaine depending on the dose and routes of administration induces profound hyperthermia, increased plasma and brain serotonin levels leading to BBB breakdown and brain edema formation. Furthermore, cocaine was able to enhance cellular stress as seen by upregulation of heat shock protein (HSP 72 kD) expression and resulted in marked neuronal and glial cell damages at the time of the BBB dysfunction. Taken together, these observations are the first to suggest that cocaine-induced BBB disruption is instrumental in precipitating brain pathology. The possible mechanisms of cocaine-induced BBB breakdown and neurotoxicity are discussed.
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Affiliation(s)
- Hari S Sharma
- Laboratory of Cerebrovascular Research & Pain Research Laboratory, Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, University Hospital, Uppsala University, SE-75185 Uppsala, Sweden
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Restrepo CS, Rojas CA, Martinez S, Riascos R, Marmol-Velez A, Carrillo J, Vargas D. Cardiovascular complications of cocaine: imaging findings. Emerg Radiol 2008; 16:11-9. [PMID: 18773229 DOI: 10.1007/s10140-008-0762-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 08/20/2008] [Indexed: 10/21/2022]
Abstract
Cocaine is the second most commonly abused illicit drug in the US and the most common one involved in emergency department visits, the majority of which are related to the cardiovascular system. Cardiovascular complications related with cocaine abuse include myocardial ischemia and infarction, myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic dissection, thrombosis, stroke and cerebral hemorrhage, and different forms of visceral ischemia, among others. In an era where cocaine use has reached epidemic proportions, it is necessary for the radiologist to understand the pathophysiology, clinical presentation, and imaging characteristics of its cardiovascular complications.
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Affiliation(s)
- Carlos S Restrepo
- Thoracic Radiology, The University of Texas HSC at San Antonio, San Antonio, TX 78229-3900, USA.
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Ferris MJ, Mactutus CF, Booze RM. Neurotoxic profiles of HIV, psychostimulant drugs of abuse, and their concerted effect on the brain: current status of dopamine system vulnerability in NeuroAIDS. Neurosci Biobehav Rev 2008; 32:883-909. [PMID: 18430470 PMCID: PMC2527205 DOI: 10.1016/j.neubiorev.2008.01.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 01/09/2008] [Accepted: 01/13/2008] [Indexed: 12/21/2022]
Abstract
There are roughly 30-40 million HIV-infected individuals in the world as of December 2007, and drug abuse directly contributes to one-third of all HIV infections in the United States. Antiretroviral therapy has increased the lifespan of HIV-seropositives, but CNS function often remains diminished, effectively decreasing quality of life. A modest proportion may develop HIV-associated dementia, the severity and progression of which is increased with drug abuse. HIV and drugs of abuse in the CNS target subcortical brain structures and DA systems in particular. This toxicity is mediated by a number of neurotoxic mechanisms, including but not limited to, aberrant immune response and oxidative stress. Therefore, novel therapeutic strategies must be developed that can address a wide variety of disparate neurotoxic mechanisms and apoptotic cascades. This paper reviews the research pertaining to the where, what, and how of HIV and cocaine/methamphetamine toxicity in the CNS. Specifically, where these toxins most affect the brain, what aspects of the virus are neurotoxic, and how these toxins mediate neurotoxicity.
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Affiliation(s)
- Mark J Ferris
- University of South Carolina, Program in Behavioral Neuroscience, Columbia, SC 29208, United States.
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Vannemreddy P, Caldito G, Willis B, Nanda A. Influence of cocaine on ruptured intracranial aneurysms: a case control study of poor prognostic indicators. J Neurosurg 2008; 108:470-6. [DOI: 10.3171/jns/2008/108/3/0470] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to determine whether cocaine use is a significant prognostic factor for outcome measures such as Hunt and Hess grade and Glasgow Outcome Scale (GOS) score among patients presenting with ruptured intracranial aneurysms (IAs).
Methods
The authors performed a MEDLINE/PubMed search for cases of ruptured IAs associated with cocaine use. Fourteen cases from the authors' experience were combined with 50 from a literature review, for a total of 64 cases associated with cocaine use. These 64 cases were compared with 65 cases without cocaine use (controls), which had been obtained from an aneurysm database. Logistic regression analysis was performed to determine significant prognostic factors for a poor Hunt and Hess grade and a poor GOS score, and a general linear model was applied to identify significant factors for these measures among cocaine users.
Results
There were 40 women in each group. The mean age was 32.3 ± 8.1 years in the cocaine group and 49.7 ± 10.6 years in the control group; thus, patients in the cocaine group were significantly younger (p < 0.01). Cocaine was snorted in 21% of cases, smoked in 55%, and intravenously injected or taken in through a combination of routes in 24%. Fifty-one percent of cocaine users and 7.7% of nonusers presented with a poor GOS score (p < 0.01). Fifty-six percent had ictus during cocaine abuse. At the end of a 30-day follow-up, 51% of the patients in the cocaine group had a good GOS score compared with 92% in the control group (p < 0.01). Controlling for the effects of other significant factors, cocaine use had a significant effect on Hunt and Hess grade (p < 0.03) and GOS score (p < 0.01). The odds of having a poor Hunt and Hess grade among cocaine users were 4.2 times greater than those in nonusers, and the odds of having a poor GOS score among cocaine users were 38.8 times greater.
Conclusions
Aneurysms were significantly smaller and ruptured at a younger age among cocaine users compared with nonusers. Although the poor clinical grade was not significantly different between the 2 groups, outcome was significantly worse in cocaine users.
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22
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Glauser J, Queen JR. An overview of non-cardiac cocaine toxicity. J Emerg Med 2007; 32:181-6. [PMID: 17307630 DOI: 10.1016/j.jemermed.2006.05.044] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Revised: 09/07/2005] [Accepted: 05/17/2006] [Indexed: 10/23/2022]
Abstract
Cocaine use in the United States continues to be a significant problem. Cocaine use is responsible for approximately 143,000 Emergency Department visits annually. The cardiac effects of cocaine are well known and much is written on this topic; this is beyond the scope of this article. Cocaine use is also responsible for a variety of non-cardiac, systemic complications, which it is our purpose to review. Multiple systemic effects of cocaine are seen with both acute and chronic use. These systems include: psychological and psychiatric, neurological, renal, pulmonary, gastrointestinal, obstetrical, and otolaryngological.
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Affiliation(s)
- Jonathan Glauser
- Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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23
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Salloum IM, Douaihy A, Ndimbie OK, Kirisci L. Concurrent Alcohol and Cocaine Dependence Impact on Physical Health Among PsychiatricPatients. J Addict Dis 2004; 23:71-81. [PMID: 15132343 DOI: 10.1300/j069v23n02_05] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to examine the association between active, concomitant cocaine and alcohol dependence and the prevalence and patterns of comorbid physical disorders in a sample of substance abusing hospitalized psychiatric patients. Three groups of patients (concomitant cocaine and alcohol dependence (AD + CD) (N = 38), alcohol dependence (AD) only (N = 38), and cocaine dependence (CD) only (N = 25)) consecutively admitted to a psychiatric-substance abuse dual diagnosis unit were comparatively examined for the frequency of comorbid physical disorders diagnoses, including viral hepatitis, sexually transmitted diseases, and on liver function tests and electrocardiographic abnormalities. The results indicated that the concomitant alcohol and cocaine dependence group had higher rates of multiple physical disorders and also of multiple hepatitis infections than either the alcohol-only or the cocaine-only groups.
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Affiliation(s)
- Ihsan M Salloum
- Addiction Medicine Services, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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24
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25
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Büttner A, Weis S. Central Nervous System Alterations in Drug Abuse. FORENSIC PATHOLOGY REVIEWS 2004. [DOI: 10.1007/978-1-59259-786-4_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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26
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Lee JH, Telang FW, Springer CS, Volkow ND. Abnormal brain activation to visual stimulation in cocaine abusers. Life Sci 2003; 73:1953-61. [PMID: 12899920 DOI: 10.1016/s0024-3205(03)00548-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chronic cocaine abuse has been associated with cerebrovascular pathology. This is likely to reflect its vasoactive effects; cocaine produces vasoconstriction and reduces cerebral blood flow. We propose that cerebrovascular pathology in chronic cocaine abusers would result in abnormal BOLD [blood oxygenation level dependent] responses to activation stimuli. Here, we used fMRI to compared the BOLD response to photic visual stimulation in neurologically intact active cocaine abusers to that in non-drug-using healthy controls. Cocaine abusers showed a significantly enhanced positive BOLD response to photic stimulation when compared to control subjects. The enhanced activation in the cocaine abusers could result from low resting cerebral blood flow secondary to increased vasoconstriction and/or from low oxidative metabolism during activation. Alternatively, the larger signal intensity in the cocaine abusers could result from inefficient neuronal processing as has been shown to occur in other conditions of cerebral pathology. These findings provide evidence of cerebral dysfunction with chronic cocaine abuse, which could reflect cerebral blood flow or neuronal changes. Further studies are required to determine if the cerebrovascular changes we observed in the cocaine abusers recover with detoxification and to assess their functional consequences.
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Affiliation(s)
- Jing-Huei Lee
- Chemistry Department, Brookhaven National Laboratory, Upton, NY 11973-5000, USA
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27
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Abstract
There is a significant variation in the management of ICH by neurologists, neurosurgeons, and emergency physicians. Most of the randomized clinical therapeutic trials have focused on subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS). Well-organized practice guidelines are now available for the management of ICH. Exciting research areas are being aggressively explored. Medical and surgical interventions for SAH, AIS, and ICH are always time-dependent, which places additional responsibility on the EP to correctly and promptly recognize these conditions to prevent further injury. The time-dependent care of these patients places the EP on the front lines of future stroke care. Special thanks to Dr. Daniel Woo and Dr. Stewart Wright for their assistance in reviewing the manuscript and Amy Hess for preparation of the manuscript.
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Affiliation(s)
- Peter D Panagos
- Department of Emergency Medicine, University of Cincinnati Medical Center, P.O. Box 67069, Cincinnati, OH 45267-0769, USA.
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28
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Affiliation(s)
- R J Hadfield
- Intensive Care Unit, Liverpool Hospital, University of New South Wales, Locked bag 7103, Liverpool BC, NSW 1871, Sydney, Australia
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29
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Neiman J, Haapaniemi HM, Hillbom M. Neurological complications of drug abuse: pathophysiological mechanisms. Eur J Neurol 2000; 7:595-606. [PMID: 11136345 DOI: 10.1046/j.1468-1331.2000.00045.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Drug abuse is associated with a variety of neurological complications. The use of certain recreational drugs shows a marked temporal association with the onset of both haemorrhagic and ischaemic strokes, the majority of which develop within minutes to 1 h after the administration of the index drug. Delayed onset of stroke has also been observed. Acute, severe elevation of blood pressure, cardiac dysrhythmias, cerebral vasospasm, vasculitis, embolization due to infective endocarditis or dilated cardiomyopathy, embolization due to foreign material injected with the diluents under non-sterile conditions and 'street drug' contaminants with cardiovascular effects have been suggested as possible underlying mechanisms. Rupture of aneurysms and arteriovenous malformations have been detected in up to half of the patients with haemorrhagic stroke due to cocaine abuse. The less common findings reported have included a mycotic cerebrovascular aneurysm in a patient with infective endocarditis and haemorrhagic stroke. In addition to stroke, cocaine seems to provoke vascular headache. Seizures precipitated by recreational drug abuse are usually caused by acute intoxication in contrast to the withdrawal seizures encountered in subjects with alcohol abuse. Movement disorders and cerebral atrophy correlating with the duration of abuse have been described. Snorting of organic solvents may cause encephalopathy. Cases of spongiform leukoencephalopathy in heroin addicts have also been reported. Peripheral neuropathy is occasionally precipitated by drug poisoning after intravenous administration. Impurities of the drug, risky administration techniques, and the use of mixtures of various drugs, frequently with simultaneous alcohol drinking, should be taken into account when assessing the background of the adverse event as well as the overall lifestyle of the addicted subjects.
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Affiliation(s)
- J Neiman
- Northern Stockholm Center for Treatment of Drug and Alcohol Dependence, Danderyd, Sweden.
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30
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Nanda A, Vannemreddy PS, Polin RS, Willis BK. Intracranial aneurysms and cocaine abuse: analysis of prognostic indicators. Neurosurgery 2000; 46:1063-7; discussion 1067-9. [PMID: 10807237 DOI: 10.1097/00006123-200005000-00006] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The outcome of subarachnoid hemorrhage associated with cocaine abuse is reportedly poor. However, no study in the literature has reported the use of a statistical model to analyze the variables that influence outcome. METHODS A review of admissions during a 6-year period revealed 14 patients with cocaine-related aneurysms. This group was compared with a control group of 135 patients with ruptured aneurysms and no history of cocaine abuse. Age at presentation, time of ictus after intoxication, Hunt and Hess grade of subarachnoid hemorrhage, size of the aneurysm, location of the aneurysm, and the Glasgow Outcome Scale score were assessed and compared. RESULTS The patients in the study group were significantly younger than the patients in the control group (P < 0.002). In patients in the study group, all aneurysms were located in the anterior circulation. The majority of these aneurysms were smaller than those of the control group (8 +/- 6.08 mm versus 11 +/- 5.4 mm; P = 0.05). The differences in mortality and morbidity between the two groups were not significant. Hunt and Hess grade (P < 0.005) and age (P < 0.007) were significant predictors of outcome for the patients with cocaine-related aneurysms. CONCLUSION Cocaine use predisposed aneurysmal rupture at a significantly earlier age and in much smaller aneurysms. Contrary to the published literature, this group did reasonably well with aggressive management.
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Affiliation(s)
- A Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport 71130-3932, USA.
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31
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Abstract
Intracerebral hemorrhage (ICH) represents a significant fraction of all strokes and causes a disproportionate amount of stroke related morbidity and mortality, especially in young blacks. While diagnosis of this disorder has greatly improved in the CT era, morbidity and mortality remain essentially unchanged. Not one currently utilized therapeutic modality has been clearly associated with a beneficial effect on long term outcome in small prospective randomized treatment trials for ICH. In spite of the lack of scientific data regarding therapy, patients often require aggressive medical and surgical intervention because of the life-threatening presentation of many patients. Recent clinical and experimental ICH research has identified a number of potentially effective new therapeutic strategies, and time to treatment is likely to be very important as it is for ischemic stroke. Large prospective, randomized, placebo controlled trials to examine the judicious application of current therapeutic modalities, and to investigate the potential benefit of proposed new treatment modalities, are long overdue.
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Affiliation(s)
- J M Gebel
- Assistant Professor of Neurology, Stroke Institute, University of Pittsburgh Medical Center, PA 15213, USA
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32
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Abstract
Cocaine use is associated with a variety of serious neurological complications, including cerebral infarction, intracerebral and subarachnoid hemorrhage, transient ischemic attacks, migraines, and seizures. We report two cases of intracerebral hemorrhage with biopsy-proven cerebral vasculitis associated with the use of cocaine. The first case involved a 32-year-old man who presented with headache, left-sided hemiparesis, and severe hypertension and who was found to have a large right putaminal hemorrhage on cranial tomographic (CT) scan. Cerebral angiography did not show vasculitic changes, but brain tissue obtained during hematoma evacuation revealed a nonnecrotizing leukocytoclastic angiitis of the small vessels. The second case involved a 20-year-old man who presented with headache, agitation, and speech difficulty that progressed to disorientation and dysphasia. He had a large left temporoparietal hematoma seen on CT scan. Cerebral angiography was consistent with vasculitis, and brain tissue obtained during hematoma evacuation revealed a small vessel vasculitis. In both cases, thorough clinical and laboratory investigations found no evidence of systemic vasculitis or an etiologic agent other than cocaine. We also critically reviewed the previously reported cases of cocaine-associated cerebral vasculitis and the relevant medical literature to discuss the "cocaine-associated vasculitis syndrome" in the context of more established vasculitidies, including hypersensitivity vasculitis. In addition, we outline a diagnostic and therapeutic approach to patients with possible cocaine-associated vasculitis.
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Affiliation(s)
- P A Merkel
- Department of Medicine, Massachusetts General Hospital, Boston, 02114, USA
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33
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Li KL, Suojanen JN. Cocaine-induced changes in time course of regional cerebral blood volume and transit time as determined by dynamic MR imaging. J Magn Reson Imaging 1995; 5:715-8. [PMID: 8748491 DOI: 10.1002/jmri.1880050616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We examined cocaine-mediated change in regional cerebral blood volume (rCBV) and mean transit time (MTT) in central brain structures of rats using functional MR imaging techniques. Changes in MTT and rCBV in animals who had previously been given cocaine depended on the length of time between the last pretreatment injection and the acute injection and seemed to parallel cocaine-mediated changes in extracellular dopamine concentrations.
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Affiliation(s)
- K L Li
- Department of Radiological Sciences, Deaconess Hospital, Harvard Medical School, Boston, MA 02215, USA
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34
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Allen MH, Fauman MA, Morin SF. Emergency psychiatric evaluation of "organic" mental disorders. NEW DIRECTIONS FOR MENTAL HEALTH SERVICES 1995:45-55. [PMID: 7476809 DOI: 10.1002/yd.23319650307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The emergency psychiatrist must first differentiate abnormal behavior with a medical etiology from that caused by so-called functional processes. Delays in diagnosis can be catastrophic and make a compelling argument for physician involvement in emergency mental health care.
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Affiliation(s)
- M H Allen
- Comprehensive Psychiatric Emergency Program, Bellevue Hospital, New York City, USA
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35
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Tennant F, Sagherian ATA, Loveland DB. A Placebo-Controlled Elimination Study to Identify Potential Treatment Agents for Cocaine Detoxification. Am J Addict 1993. [DOI: 10.1111/j.1521-0391.1993.tb00432.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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