Linear CT-scan measurements in alcohol-dependent patients with and without delirium tremens.

The aims of the present study were to examine whether chronic alcohol dependence and the development of delirium tremens are characterized by changes in linear CT measurements of brain liquor spaces and intracranial distances indicative of prefrontal atrophy, and frontal (sub)cortical or temporal (sub)cortical atrophy. Toward this end linear measurements were performed in 47 alcohol dependent patients with and without a history of delirium tremens and in 10 healthy volunteers using CT-scanning. The following linear measurements were calculated: (1) the Evans ratio; (2) the cella media index (CMI); (3) the maximum width of the third ventricle; (4) the maximum width of the fourth ventricle; (5) the maximum frontal subarachnoid space (MFSS); (6) the maximum width of the anterior interhemispheric fissure (MIF), and (7) the maximum width of the Sylvian fissure (MSF). The alcoholics were divided into subgroups according to the Münchner Alkoholismus Test (MALT) and the presence of delirium tremens. The MFSS of the alcohol-dependent patients was significantly larger than that of the controls. The MIF and MSF of high MALT scorers were significantly larger than those of low scorers and controls. Alcohol-dependent patients with a known history of delirium tremens had significantly larger MIF and MSF than did patients without delirium tremens and controls. The results suggest that alcohol dependence is characterized by prefrontal atrophy, and that frontal cortical and temporal (sub)cortical atrophy may be related to the development of delirium tremens.

Dopamine transporter availability and depressive symptoms during alcohol withdrawal.

Alcohol-related temporary depressive symptoms are hypothesized to be related to dopaminergic dysfunction. The aim of this study was to investigate whether or not depressive symptoms correlate with reduced dopamine transporter (DAT) availability. We studied the DAT availability in 28 alcoholic subjects with beta-CIT ([123-iodium]-2-betacarbomethoxy-3-beta-(4-iodophenyl)-tropa ne) single photon emission tomography (SPET) and found a reduction in DAT availability during withdrawal that subsequently showed a significant increase during sobriety. The relationship between DAT availability and Montgomery-Asberg Depression Rating scale scores, both during withdrawal and after sobriety, was assessed. The main finding was a statistically significant correlation between DAT variances and depressive symptom scores during both states. The findings indicate a possible dopaminergic etiology for depressive symptoms in alcohol withdrawal, which suggests that dopaminergic antidepressants might be beneficial in the treatment of alcohol withdrawal.

[Bilateral acetabulum fractures of the anterior column and vertebral body fracture after alcohol-induced seizure]. / Bilaterate Acetabulumfrakturen der vorderen Pfeiler und Wirbelkörperfraktur nach alkoholinduziertem Krampfanfall.

The case of a 54-year-old male with a compression fracture of the T 12 vertebral body and a bilateral anterior column fracture of the acetabulum is presented. The origin of this rare combination of fractures is explained by the action of the patient's own muscle force on bone of very poor quality. The treatment of these lesions is comparable to the treatment of similar fractures in bone of normal quality.

Alcoholic withdrawal syndrome and seizures.

A study of 72 alcoholics, hospitalized for alcohol withdrawal syndrome, was undertaken to determine the incidence of seizures, their relationship with other withdrawal symptoms, the presence of brain atrophy and the relationship of this last with withdrawal intensity severity. Sixty-seven (93%) were male and the mean age was 44.9 +/- 1.3 (mean +/- SEM) years. Thirty-three (46%) of the 72 patients had seizures at admission, 10 of these developed minor withdrawal symptoms, in 18 delirium tremens ensued and 5 showed no symptoms of withdrawal. Thirty-nine (54%) had withdrawal syndrome without seizures. Twenty-one of these developed minor withdrawal syndrome and 18 delirium tremens. Seizures showed no relationship with the other withdrawal manifestations, and in all the cases preceded them. Our findings also show that alcoholics with seizures due to withdrawal are more prone to suffer seizures in their future withdrawal episodes, and that alcoholics who suffer morning withdrawal symptoms are prone to develop delirium tremens. In 46 patients a CT scan was performed. Though the alcoholics showed ventricular and sulcal enlargement, brain atrophy was similar when the seizure and non-seizure groups or those with and without delirium tremens were compared. However, cortical and ventricular atrophy were related to the existence of previous episodes of withdrawal syndrome [corrected].

Volume and surface three-dimensional displays of Tc-99m HMPAO brain SPECT imaging in a chronic hypnosedative abuser.

An alcohol- and diazepam-abusing patient underwent brain CT and SPECT imaging studies. The CT scan showed mild brain atrophy, whereas SPECT imaging using Tc-99m HMPAO showed a large lesion in the left cerebral hemisphere. The extent of lesion involvement was appreciated by three-dimensional displays. This finding was associated with a clinical presentation of hypnosedative withdrawal delirium (disorientation, impaired memory, rambling speech with loose associations, paranoia, ideation, restlessness, poor judgment). Tc-99m HMPAO SPECT may provide objective documentation of regional cerebral neurochemical alteration associated with hypnosedative abuse or hypnosedative withdrawal states, whereas surface and volume three-dimensional displays simplify and enhance brain SPECT image interpretation.

The pattern of regional cerebral blood flow during alcohol withdrawal--a single photon emission tomography study with 99mTc-HMPAO.

Cerebral blood flow was investigated during alcohol withdrawal in 15 male alcoholics by single photon emission computerized tomography with 99mTc-HMPAO and compared with the results of a second study 3 weeks later when all symptoms of withdrawal had disappeared and when the patients had been free of medication for at least 1 week. Slice images were reconstructed parallel to the orbitomeatal plane, and tracer activity was analyzed in 8 regions of interest per hemisphere. During alcohol withdrawal a special pattern of cerebral blood flow distribution could be observed. Relative perfusion was elevated in both inferior temporal regions, whereas it was reduced in the superior temporal region of both hemispheres. The changes of cerebral blood flow distribution did not correlate with neuropsychological findings nor with the severity of withdrawal syndrome.

Computerized tomographic study on the brain of patients with alcohol dependence.

One hundred ten patients with alcohol dependence and 56 psychiatric patients with either senile dementia, amphetamine psychosis, epilepsy or chronic schizophrenia were investigated with a CT scan of the brain. The maximum width of the 3rd ventricle was measured, and the presence/absence of enlargement of the lateral ventricle and of atrophy of the frontal lobe was determined independently by 3 physicians. The width of the 3rd ventricle in alcoholic and the other patients examined was gradually enlarged with aging, and the width in these patients was significantly larger than that in the age-matched control patients who were selected from the patients with amphetamine psychosis, epilepsy or schizophrenia. The enlargement of the lateral ventricles observed in the alcoholic patients always accompanied the enlargement of the 3rd ventricle, but not vice versa. The alcoholic patients with frontal lobe atrophy showed a higher incidence of withdrawal delirium than the patients without atrophy. These findings suggest that the chronic intake of alcohol might affect primarily the area around the 3rd ventricle, resulting in enlargement of this ventricle and consequential enlargement of the lateral ventricles and also that the alcoholic patients with frontal lobe atrophy could have a high risk for a manifestation of alcoholic withdrawal delirium.