title: Magnetic resonance imaging of severe, long-term, opiate-abuse patients without neurologic symptoms may show enlarged cerebrospinal spaces but no signs of brain pathology of vascular origin.
abstract: BACKGROUND
  Recreational drug abuse is one of the most important risk factors for stroke in young adults. Abuse of opiates may lead to severe acute neurologic problems due to ischemia or hemorrhage. In contrast, their minor effects on brain structures are not well established. We evaluated brain magnetic resonance images (MRI) of opiate-dependent subjects who had no major neurologic symptoms or psychiatric disorder.
  
  
  METHODS
  Seventeen opiate-dependent patients and 17 controls underwent 1.5 T MRI. Any abnormalities in signal intensity of the brain were recorded. Areas of vermis, corpus callosum, and midline internal skull surface (MISS) were measured from midline sagittal slice. To evaluate size of cortical sulci, sylvian fissures, and ventricles, axial images were compared with standard sets of reference images. In addition, bifrontal and sylvian-fissure ratios were measured.
  
  
  RESULTS
  Only one patient had a small subcortical post-traumatic lesion; otherwise, gray and white matter showed normal signal intensities. Opiate-dependent subjects had significantly wider sylvian fissures (p=0.008, Mann-Whitney U) and larger ventricles (p=0.04) than controls. Bifrontal and sylvian-fissure ratios were significantly higher in patient group than in controls (p=0.013 and p=0.005, respectively).
  
  
  CONCLUSIONS
  No signs of brain pathology of vascular origin were found. From the clinical point of view, we want to emphasize that in the first acute neurologic attack of opiate-dependent patients, any abnormal signal intensity in MRI is most probably associated with the patient's current situation. Sylvian fissures and ventricles were wider in opiate-dependent subjects than in controls, which may be related to brain atrophy located especially in frontal and temporal lobes.
authors.affiliation: Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Reetta
authors.initials: R
authors.lastname: Kivisaari
authors.forename: Seppo
authors.initials: S
authors.lastname: Kähkönen
authors.forename: Varpu
authors.initials: V
authors.lastname: Puuskari
authors.forename: Olga
authors.initials: O
authors.lastname: Jokela
authors.forename: Pekka
authors.initials: P
authors.lastname: Rapeli
authors.forename: Taina
authors.initials: T
authors.lastname: Autti
mesh_terms: D000328:Adult; D001808:Blood Vessels / Q000033:anatomy & histology* / Q000473:pathology; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects / Q000494:pharmacology; D009422:Nervous System Diseases / Q000139:chemically induced*; D009293:Opioid-Related Disorders / Q000473:pathology*; D011859:Radiography; D012307:Risk Factors
chemical_list: D009294:Narcotics