The Whole Spectrum of Alcohol-Related Changes in the CNS: Practical MR and CT Imaging Guidelines for Daily Clinical Use

Abstract

Alcohol addiction is the most common drug addiction. Alcohol passes both the placenta as well as the blood-brain barrier and is in multiple ways neurotoxic. Liver diseases and other systemic alcohol-related diseases cause secondary damage to the CNS. Especially in adolescents, even a single episode of severe alcohol intoxication (“binge drinking”) may result in life-threatening neurological consequences. Alcohol-related brain and spinal cord diseases derive from multiple causes including impairment of the cellular metabolism, often aggravated by hypovitaminosis, altered neurotransmission, myelination and synaptogenesis as well as alterations in gene expression. Modern radiological diagnostics, MRI in particular, can detect the resulting alterations in the CNS with a high sensitivity. Morphological aspects often strongly correlate with clinical symptoms of the patient. It is less commonly known that many diseases considered as “typically alcohol-related”, such as Wernicke’s encephalopathy, are to a large extent not alcohol-induced. Visible CNS alterations are thus non-pathognomonic and demand careful evaluation of differential diagnoses. This review article elucidates the pathogenesis, clinical aspects and radiological image features of the most common alcohol-related CNS diseases and their differential diagnoses.

Key Points:

• Alcohol-associated changes in the CNS are common and radiologically assessable.

• They are often subtle and allow multiple differential diagnoses besides alcohol consumption.

• Knowledge of clinical exams and lab results is crucial for diagnostic accuracy.

Citation Format:

• Keil VC, Greschus S, Schneider C et al. The Whole Spectrum of Alcohol-Related Changes in the CNS: Practical MR and CT Imaging Guidelines for Daily Clinical Use. Fortschr Röntgenstr 2015; 187: 1073 – 1083

Zusammenfassung

Alkoholabhängigkeit ist die häufigste Form der Drogenabhängigkeit. Alkohol ist liquor- und plazentagängig und auf komplexe Weise neurotoxisch. Lebererkrankungen und systemische Alkoholfolgeerkrankungen führen zu sekundären ZNS-Schäden. Selbst ein einmaliger Alkoholrausch („binge drinking“) kann, insbesondere für Jugendliche, lebensbedrohliche neurologische Folgen haben. Das Ursachenspektrum alkoholassoziierter Hirn- und Rückenmarkserkrankungen betrifft Störungen des zellulären Energiestoffwechsels durch Alkohol oder alkoholassoziierten Vitaminmangel, die Neurotransmission, die Myelinisierung und Synaptogenese sowie die Genexpression. Im Alltag sind die damit einhergehenden ZNS-Veränderungen mit moderner Schnittbilddiagnostik, insbesondere der MRT, mit hoher Sensitivität nachweisbar und korrelieren oft mit der klinischen Symptomatik des Patienten. Dabei gilt es zu beachten, dass viele als typisch alkoholbedingt bekannte Erkrankungen, wie z. B. die Wernicke-Enzephalopathie und die osmotische Demyelinisierung, zu einem großen Anteil nicht durch Alkoholabusus verursacht werden. Die bildmorphologischen Veränderungen sind demnach nicht pathognomonisch und eine sogfältige klinische Abwägung der Differenzialdiagnosen ist erforderlich. In dieser Übersichtsarbeit werden die Pathogenese, Klinik und Bildmorphologie häufiger alkoholassoziierter ZNS-Erkrankungen und ihrer Differenzialdiagnosen dargelegt.

Key words

brain - CNS - spinal cord - MR imaging

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