Recreational substance use neuroimaging reveals a wide spectrum of acute and chronic central nervous system abnormalities that radiologists frequently encounter in the emergency department, highlighting the importance of rapid recognition for patient management.
Neuroimaging Context and Public Health Impact
Recreational substance use remains a major global public health concern and is associated with substantial preventable morbidity and mortality. Commonly consumed substances include alcohol, cannabinoids, opioids, benzodiazepines, amphetamines, cocaine, and inhalants. Due to the high prevalence of substance use related presentations in emergency settings, radiologists are increasingly required to identify neuroimaging patterns that may indicate acute intoxication, chronic exposure, or secondary complications. The diversity of substances, routes of administration, and potential contaminants contributes to a broad range of imaging findings, making familiarity with these patterns essential for accurate interpretation.
Cerebrovascular and Toxic Metabolic Findings
Recreational substance use neuroimaging often demonstrates cerebrovascular complications that affect both structural and functional integrity of intracranial perfusion. These abnormalities can present acutely or develop over time depending on exposure patterns. In addition, toxic and metabolic entities represent a heterogeneous group of conditions. Alcohol related complications form a significant subset and may coexist with nutritional or metabolic derangements. Opioid toxidromes and other toxic leukoencephalopathies are also recognised manifestations, reflecting direct neurotoxicity or secondary metabolic effects. Imaging appearances vary widely and may overlap, requiring careful correlation with clinical presentation.
Infectious Complications and Diagnostic Implications
Infectious entities are particularly associated with intravenous substance use and represent another important category within recreational substance use neuroimaging. These include bacterial infections, conditions related to human immunodeficiency virus, and opportunistic infections. Such findings often carry prognostic significance and may alter acute therapeutic decisions. Prompt identification and clear communication of suspected substance related pathology can support timely intervention, guide further diagnostic testing, and improve overall patient outcomes.
Radiologists interpreting emergency neuroimaging examinations are encouraged to maintain a high index of suspicion for substance related aetiologies when evaluating unexplained central nervous system findings. Awareness of the broad spectrum of imaging manifestations linked to recreational substance use neuroimaging is critical for optimal clinical management and accurate prognostication in this complex patient population.
Reference
DeFreitas MR et al. Neuroimaging patterns of recreational drug use in the emergency setting. RadioGraphics. 2026;46:2.
