Alcohol-induced psychotic disorder: brain perfusion and psychopathology--before and after anti-psychotic treatment.

Alcohol-induced psychotic disorder (AIPD) also known as alcohol hallucinosis is a rare complication of alcohol abuse. The pathogenesis and treatment of AIPD are still unclear. Few prospective treatment studies are available but case reports generally suggest that anti-psychotic treatment is effective. Brain imaging changes in relation to treatment response have also not been studied except for case reports. The aim of this study was to investigate the effect of anti-psychotic treatment on psychopathology and regional cerebral blood flow (rCBF) in patients with AIPD before and after 6 weeks of treatment. Nineteen patients with AIPD were assessed by the Positive and Negative Syndrome Scale (PANSS) and single photon emission computed tomography (SPECT) before and after 6-weeks of open-label treatment with a fixed dose of haloperidol (5 mg/day). Highly significant improvements were noted on the positive, general and total scores of the PANSS. Post-treatment increased rCBF to the left caudate and left frontal lobe was noted. Changes in frontal, temporal, parietal, occipital, thalamic and cerebellar rCBF showed significant negative correlations with the degree of symptom improvement, suggesting dysfunction of these areas in AIPD. Psychopathological and rCBF findings suggest reversible generalised cerebral dysfunction in AIPD.

[Clinical and lesion-related bases of alcoholic brain damage]. / Fundamentos lesionales y clínicos del daño cerebral alcohólico.

Alcohol-induced brain damage is known since long, with classical descriptions of lesions. There is no constant correlation between them and any of the clinical presentations of chronic intoxication. New neuroimaging techniques, neuropsychology and basic investigation have supplied with new data. The so-called alcoholic dementia and its possible reversibility are major issues of this problem. This paper reviews radiological, pathological, vascular and neuropsychological studies related to this point.

Neuroradiologic abnormalities in Marchiafava-Bignami disease of benign evolution.

Marchiafava-Bignami disease has been recognized since 1903, but only recently has it become possible to achieve a probable diagnosis before death occurs. Imaging of the central nervous system with MR and CT have contributed significantly to such a diagnosis. Two cases of the disease are reported in patients, aged 33 and 59 years, with benign evolution of neurologic symptoms the diagnosis was confirmed by neurologic imaging with MR and CT and both were studied with evoked responses. Reversibility of the disease and possible prognostic indicators in these and other patients reported in the literature are discussed. The important role that diagnostic procedures, especially MR imaging, play in the management of this disease is emphasized.

Positron emission tomography as a technique for studying the chronic effects of alcohol on the human brain.

Positron emission tomography is a neuroradiographic imaging technique that is beginning to be used to study cerebral pathophysiology in detoxified alcoholics. Localized cerebral glucose utilization in alcoholics at rest is not dramatically affected in comparison to the relatively large alterations in anatomic structure, cognition, and brain electrical activity. It is anticipated that future research studies will include cognitive challenges and utilization of PET ligands being developed to bind to specific receptors in the brain.

Iodine-123 iodoamphetamine brain scan in a patient with auditory hallucination.

The case of an alcoholic patient with auditory hallucination is reported in which [123I] iodoamphetamine (IMP) brain imaging demonstrated increased accumulation in the left superior temporal lobe which corresponded to the left primary and secondary auditory areas. Thus, IMP brain scans seem to have the potential to objectively localize the brain abnormalities in auditory hallucination.

Brain damage in alcoholism: current concepts.

Current views concerning the brain damage occasioned by alcohol abuse are reviewed. Diffuse cerebral changes appear to be common and partially reversible with prolonged abstinence. The possible determinants of such changes, and their relevance to functional deficits are discussed, with illustrations from work currently proceeding at the Institute of Psychiatry. Possible interactions between cortical and subcortical pathologies in contributing to the cognitive deficits shown by alcoholic patients are emphasised.

[Brain atrophy in chronic alcoholism. Clinical and computer tomographic study]. / Hirnatrophische Veränderungen bei chronischem Alkoholismus. Eine klinische und computertomographische Studie.

Fifty chronic alcoholics (37 men and 13 women, ages 26--55, mean age 39.9 years) with different clinical syndromes (alcoholic psychosis, alcoholic encephalopathies) were studied by computerized cranial tomography. Cerebral atrophy was detected in 96% of all cases. Combined cortical and subcortical signs were encountered in almost all cases. Cortical atrophy seemed to be detectable more easily by CT than by pneumencephalography. The computerized tomographic findings were studied in their relations to age, sex, duration of abuse, clinical syndromes, frequency of relapse (and seizures, too), etc. Cerebral atrophy was correlated primarily with the subjects' age and the duration, and less with the intensity of alcoholism. The most distinct changes were found in delirium syndromes and, in cases with relapse of psychosis, especially in combination with seizures. Wernicke-Korsakow encephalopathies showed the widest third ventricles when combined with repeated syndromes of withdrawal in their case histories. Computerized tomographic examinations of ten patients during acute psychosis as well as 4 weeks later showed identical findings; transitory changes, e.g., cerebral edema, were not detected. Computerized cranial tomography appears to be extremely useful to study the numerous open questions concerning the pathogenetic role of age, duration, and severity of abuse with cerebral atrophy.

Constancy of convexity air block on pneumoencephalography.

Twenty-two patients with dementia were examined by pneumoencephalography using special technic with the aim of filling the subarachnoid convexity space. Seven had no obvious hydrocephalus. All patients had convexity blocks which were more or less extensive. Ten had bilateral air block in the frontal, parietal and occipital regions. It was concluded that convexity air block is not a technical artifact and consequently seems to have an organic background.