8th Baltic Congress of Radiology

08.10.2022 Tallinn, Estonia

Cerebellar and brainstem atrophy in methcathinone abusers with parkinsonism

Julius Juurmaa (Estonia)

Head of radiology and clinician educator, East Tallinn Central Hospital

Biography: Julius Juurmaa is the head of radiology and clinician educator in East Tallinn Central Hospital, a guest lecturer in Tallinn University of Technology, and a doctoral student in University of Tartu. He completed basic medical studies in 2015 and residency in 2020. Radiology-related interests include cardiovascular, abdominal, and isotope imaging. Other interests range from imaging physics to structured clinical reasoning and medical error.

Presentation

Small Hall

Synopsis: Objective:
The aim of this study is to investigate structural changes in the cerebellum and brainstem underlying a parkinsonism-dystonia syndrome in intravenous abusers of a designer psychostimulant containing methcathinone and manganese. Use of this psychostimulant has been widely reported throughout the former Soviet Union and continues to be a public health hazard in these countries.
Methods:
We examined 26 intravenous drug addicts with a history of methcathinone abuse, along with 36 healthy volunteers matched on age, gender, primary language, and level of education, in a case-control study. Patients’ symptoms were assessed quantitatively using the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale and 1.0 mm isotropic T1-weighted volumes were acquired on a 3.0 T magnetic resonance tomograph. Volumetric segmentation of subcortical structures was performed in the FreeSurfer imaging analysis suite. Volumes of subcortical structures were compared between patients and healthy controls, and associations with motor symptoms were assessed, using bootstrapped linear regression.
Results:
We demonstrated loss of volume in cerebellar cortex (p < 0.0001 bilaterally) and ventral diencephalon area (p < 0.0001 bilaterally) in patients when compared to healthy controls. A trend towards smaller midbrain volume was also observed in patients (p = 0.0002). Presence of human immunodeficiency virus infection had an additional effect on cerebellar cortical volume (p = 0.005 in the left hemisphere, p = 0.003 in the right hemisphere), but not on brainstem volume. Larger cerebellar cortical volume was correlated with slightly worse motor symptoms (p = 0.03).
Conclusions:
This is the first description of volume loss in the cerebellum and brainstem underlying this parkinsonism-dystonia syndrome. The findings are in line with recently discovered subcortical connections between the basal ganglia and cerebellum; and with regionally and pathophysiologically overlapping neurotoxic mechanisms of amphetamines, manganese, and HIV infection. Further studies are needed to clarify whether these changes in volume are associated with changes in functional connectivity. Lühikokkuvõte: We investigated structural changes in the cerebellum and brainstem underyling a parkinsonism-dystonia syndrome in intravenous abusers of a designer psychostimulant containing methcathinone and manganese, widely reported throughout the former Soviet Union. We describe volume loss in the cerebellum and brainstem underying this syndrome. The findings are in line with subcortical connections between the basal ganglia, and with overlapping neurotoxic mechanisms of amphetamines, manganese, and HIV infection.

This agenda item is presented in the following session: S7-2 Neuroradiology

Plenary session

08.10.2022 13:30 - 15:00