Objective: Objective of  the study was to summarize the typical neuroradiological picture of ephedronic encephalopathy and its clinical correlates.

Background: Methcathinone (Ephedrone, Jeff etc.) emerged as widely used synthetic psychostimulant during last decades in eastern European countries. Manganese, used for the oxidation in synthesis of this drug, is highly toxic and accumulates in the brain as shown with MR imaging and experimental studies.

Methods: We have retrospectively reviewed available imaging and clinical data of 38 patients (35 male,  3 female) with ephedrone-induced encephalopathy. In 12 cases MR imaging was repeated 4-6 years after first scan. The duration of the substance abuse ranged from 1,5month to 3 years. The frequency of intravenous indication ranged from 1 injection per week to 10 injections per day. All patients underwent MRI of the brain.

Results: Abnormalities were revealed in 31 cases: there was a hyperintense signal on T1-weighted images in globus pallidus (n=31), as solitary sign, or in combination with T1-hyperintensity in substantia nigra (n=26), nucleus dentatus of cerebellum (n=17), anterior pituitary lobe (n=11) and white matter of the great hemispheres (n=3).

The most common clinical symptoms were: bradykinesia, postural disturbances, ataxia, dysarthria, dysphonia, hypometric vertical saccades, dystonia (mostly of the face and lower extremities). Substance abuse with the duration of more than 6 months was associated with deep disability which was not regressing despite the cessation of the drug.

The signal intensity on MR was higher after recent frequent use of the Methcathinone. But the signal changes were not associated with the severity and multitude of the clinical picture.  

No MR signal changes were revealed on the second scan (n=12) in studied group. At this point nonspecific cortical atrophy was detected. Despite reported cessation of the drug abuse (drug free period before second scan varied from 6 months to 5 years) there was no improvement in severity of clinical disability.

Conclusions: Hyperintense signal on T1-weighted is a sign of recent manganic intoxication, but can not be used as a biomarker of disease in case of the damage caused by manganese containing synthetic drug. There is a need of more sophisticated neuroimaging investigation of patients with ephedrone-induced encephalopathy, to study the morphologic and functional changes associated with chronic clinical signs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pattern-of-mri-findings-in-ephedronic-encephalopathy/