Brain damages in ketamine addicts as revealed by magnetic resonance imaging

Chunmei Wang, Dong Zheng, Jie Xu, Waiping Lam, D T Yew, Chunmei Wang, Dong Zheng, Jie Xu, Waiping Lam, D T Yew

Abstract

Ketamine, a known antagonist of N-methyl-D-aspartic (NMDA) glutamate receptors, had been used as an anesthetic particularly for pediatric or for cardiac patients. Unfortunately, ketamine has become an abusive drug in many parts of the world while chronic and prolonged usage led to damages of many organs including the brain. However, no studies on possible damages in the brains induced by chronic ketamine abuse have been documented in the human via neuroimaging. This paper described for the first time via employing magnetic resonance imaging (MRI) the changes in ketamine addicts of 0.5-12 years and illustrated the possible brain regions susceptible to ketamine abuse. Twenty-one ketamine addicts were recruited and the results showed that the lesions in the brains of ketamine addicts were located in many regions which appeared 2-4 years after ketamine addiction. Cortical atrophy was usually evident in the frontal, parietal or occipital cortices of addicts. Such study confirmed that many brain regions in the human were susceptible to chronic ketamine injury and presented a diffuse effect of ketamine on the brain which might differ from other central nervous system (CNS) drugs, such as cocaine, heroin, and methamphetamine.

Keywords: addiction; atrophy; brain; ketamine; lesion; magnetic resonance imaging (MRI).

Figures

Figure 1
Figure 1
Hyperintense spots (arrow) in superficial white matter and internal capsule of ketamine addicts. (A) FLAIR imaging of a 1 year ketamine addict. (B) T2 imaging of a 3 years ketamine addict.
Figure 2
Figure 2
MRI images of the brains of a 4 years ketamine addicts. (A) T2 image of a horizontal brain section showing degenerative hyperintense spots in basal forebrain (arrow). (B) T2 image of a horizontal section showing hyperintense degeneration in cerebellum (a) and in pons (b). (C) T2 image of a sagittal section showing degeneration spots in diencephalon (thalamus).
Figure 3
Figure 3
FLAIR image of diffusion blockage as hyperintense spots in the parahippocampal gyrus (G) and insula (I) as well as atrophy of uncus (arrow). (A) Ketamine addict of 4 years. (B) Ketamine addict of 5 years.
Figure 4
Figure 4
T2 image showed parietal atrophy (arrow) in a sagittal brain section of a ketamine addict of 4 years.
Figure 5
Figure 5
T2 image showed prefrontal and occipital atrophy (arrows) in a sagittal brain section of a 7 years' ketamine addict.
Figure 6
Figure 6
T2 image showed hypertensive degenerative spots in corpus striatum (arrows) of a 6 years' ketamine addicts.
Figure 7
Figure 7
T1 images showed atrophic basal prefrontal (gyrus rectus) lesion of a 0.5 years ketamine addicts who took three drugs including ketamine (A). (B) Control with no retraction of gyrus rectus (arrow).
Figure 8
Figure 8
T2 image showed significant prefrontal atrophy (arrow) in a horizontal brain section of a ketamine addict who had high dose of ketamine (3 g per day) for only 3 years.
Figure 9
Figure 9
T2 image of a coronal section that showed degenerative lesion (arrow) in the brainstem (midbrain) of a ketamine addict of 7 years.

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