Brain abnormalities detected on magnetic resonance imaging of amphetamine users presenting to an emergency department: a pilot study.

OBJECTIVES: To determine the prevalence of occult brain abnormalities in magnetic resonance imaging of active amphetamine users. DESIGN, SETTING AND PARTICIPANTS: Prospective convenience study in a tertiary hospital emergency department (ED). Patients presenting to the ED for an amphetamine-related reason were eligible for inclusion. We collected demographic data, drug use data, and performed a mini-mental state examination (MMSE). MAIN OUTCOME MEASURES: The proportion of patients with an abnormality on their MRI scan. RESULTS: Of 38 patients enrolled, 30 had MRI scans. Nineteen were male and their mean age was 26.7 +/- 5.4 years (range 19-41 years). The mean age of first amphetamine use was 18 years (range 13-26 years). Sixteen patients used crystal methamphetamine (mean amount 2.5 g/week), nine used amphetamine ("speed") (mean amount 2.9 g/week), and 23 used ecstasy (mean amount 2.3 tablets/week). Marijuana was smoked by 26 (mean amount 5.9 g/week), and 28 drank alcohol (mean amount 207 g/week). The median MMSE score was 27/30 (interquartile range, 26-29). Abnormalities on brain MRI scans were identified in six patients, most commonly an unidentified bright object (n = 4). CONCLUSION: In this pilot study of brain MRI of young people attending the ED with an amphetamine-related presentation, one in five had an occult brain lesion. While the significance of this is uncertain, it is congruent with evidence that amphetamines cause brain injury.

Unilateral lumbosacral facet joint dislocation without associated fracture.

In the lumbosacral spine, unilateral facet joint dislocation is an infrequent injury, which is often associated with fractures at the involved or other lumbar levels. The rare occurrence of unilateral lumbosacral facet joint dislocation without any associated fractures is presented with CT and MRI, and surgical correlation. To our knowledge, cross-sectional imaging of this injury has not previously been described in the published literature.