Background: Timely and correct diagnosis of poisoning is an important part of the management of poisoned patients. This study aimed to investigate the abnormal findings of brain CT scans of patients with drug overdose poisoning.
Methods: A retrospective cross-sectional study was conducted on patients with poisoning admitted to Baharloo Hospital, Tehran, Iran during 2015. Moreover, they underwent radiological assessment as a result of their decreased level of consciousness. For the purpose of the study, we examined patients’ Computerized Tomography (CT) scan reports. The collected data were analyzed with SPSS 16. Frequency and percentage frequency were calculated for qualitative variables, and mean and standard deviation were calculated for the quantitative variables.
Results: Overall, 191 patients admitted with poisoning were evaluated. Of them, 119(62.3%) had normal brain CT scans and the remaining had pathologic findings. The most common pathologic findings in the brain CT scans comprised cerebral edema (24.6%) followed by infarction (5.2%). The least common pathologic finding was cerebral herniation (0.5%). This pattern was similar in both genders and in different subtypes of poisonings, with the exception of poisoning with cardio-respiratory drugs. The most common finding in the latter type of poisoning was herniation. In cases of simultaneous head trauma, the most common pathological brain CT scan findings were cerebral edema and hemorrhage.
Conclusion: The radiological assessment of the brain following poisoning and decreased level of consciousness can help in the diagnostic evaluation of patients. It can be a life-saving measure, through timely detection of the type of poisoning and brain damage.
Murray CJL, Lopez AD. The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Geneva: World Health Organization; 1996.
Islambulchilar M, Islambulchilar Z, Kargar-Maher M. Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. Human & Experimental Toxicology. 2009; 28(4):185–90. doi: 10.1177/0960327108099679
Litovitz TL, Klein-Schwartz W, White S, Cobaugh DJ, Youniss J, Omslaer JC, et al. 2000 annual report of the American association of poison control centers toxic exposure surveillance system. The American Journal of Emergency Medicine. 2001; 19(5):337–95. doi: 10.1053/ajem.2001.25272
Lal NR, Murray UM, Eldevik OP, Desmond JS. Clinical consequences of misinterpretations of neuroradiologic CT scans by on-call radiology residents. American Journal of Neuroradiology. 2000; 21(1):124–29. PMID: 10669236
Brent J, Wallace KL, Burhart K. Critical care toxicology: Diagnosis and management of the critically poisoned patient. Philadelphia, Pennsylvania: Elsevier; 2004
Craig SA. CNS depression. In: Ford MD, Delaney KA, Ling LJ, Erickson T, editors. Radiology: Clinical Toxicology. Philadelphia, Pennsylvania: Saunders; 2001.
Marsha F, Kathleen A, Ling L, Ericson T. Clinical toxicology. Philadelphia, Pennsylvania: Saunders; 2000.
Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A et al. The Canadian CT head rule for patients with minor head injury. Lancet. 2001; 357(9266):1391-6. PMID: 11356436
Choi IS, Kim SK, Choi YC, Lee SS, Lee MS. Evaluation of outcome after acute carbon monoxide poisoning by brain CT. Journal of Korean Medical Science. 1993; 8(1):78-83. doi: 10.3346/jkms.19220.127.116.11
Henderson A, Wright M, Pond SM. Experience with 732 acute overdose patients admitted to an intensive care unit over six years. The Medical Journal of Australia. 1993; 158(1):28-30. PMID: 8417286
Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. New England Journal of Medicine. 2000; 343(2):100-5. doi: 10.1056/nejm200007133430204
Shadnia S, Esmaily H, Sasanian G, Pajoumand A, Hassanian-Moghaddam H, et al. Pattern of acute poisoning in Tehran-Iran in 2003. Human & Experimental Toxicology. 2007; 26(9):753–6. doi: 10.1177/0960327107083017
Varnell RM, Stimac GK, Fligner CL. CT diagnosis of toxic brain injury in cyanide poisoning: considerations for forensic medicine. American Journal of Neuroradiology. 1987; 8(6):1063-6. PMID: 3120533
Geibprasert S, Gallucci M, Krings T. Addictive illegal drugs: Structural neuroimaging. American Journal of Neuroradiology. 2009; 31(5):803–8. doi: 10.3174/ajnr.a1811
Lim CC. Magnetic resonance imaging findings in bilateral basal ganglia lesions. ANNALS Academy of Medicine Singapore. 2009; 38(9):795-8. PMID: 19816639
Perera KM, Powell T, Jenner FA. Computerized axial tomographic studies following long-term use of benzodiazepines. Psychological Medicine. 1987; 17(03):775-7. doi: 10.1017/s0033291700026003
Abdollahi M, Jalali N, Sabzevari O, Hoseini R, Ghanea T. A restrospective study of poisoning in Tehran. Journal of Toxicology: Clinical Toxicology. 1997; 35(4):387-93. doi: 10.3109/15563659709043371
Izadi-Mood N, Tavahen N, Masoumi GR, Gheshlaghi F, Siadat ZD, Setareh M, et al. [Demographic factors, duration of hospitalization, costs of hospitalization, and cause of death in patients intoxicated with amphetamines and opioids (Persian)]. Journal of Isfahan Medical School. 2011; 29(146):890-900.