Computed tomography of the brain, hepatotoxic drugs and high alcohol consumption in male alcoholic patients and a random sample from the general male population.

Abstract

Computed tomography (CT) of the brain was performed in a random sample of a total of 195 men and 211 male alcoholic patients admitted for the first time during a period of two years from the same geographically limited area of Greater Stockholm as the sample. The same medical, social and neuroradiological methods were used for examination of the alcoholic inpatients as for the random controls. Laboratory tests were performed, including liver and pancreatic tests. Toxicological screening was performed and the consumption of hepatotoxic drugs was also investigated and the following were the types of drugs used: antiarrhythmics, antiepileptics, antiphlogistics, mixed analgesics, barbiturates, sulphonamides, benzodiazepines, clomethiazole and phenothiazine derivatives, all of which are metabolised by the liver. The group of male alcoholic inpatients and the random sample were then subdivided with respect to alcohol consumption and use of hepatotoxic drugs: Group IA, men from the random sample with low or moderate alcohol consumption and no use of hepatotoxic drugs; IB, men from the random sample with low or moderate alcohol consumption with use of hepatotoxic drugs; IIA, alcoholic inpatients with use of alcohol and no drugs; and IIB, alcoholic inpatients with use of alcohol and drugs. Group IIB was found to have a higher incidence of cortical and subcortical changes than group IA. Group IB had a higher incidence of subcortical changes than group IA, and they differed only in drug use. Groups IIB and IIA only differed in drug use, and IIB had a higher incidence of brain damage except for anterior horn index and wide cerebellar sulci indicating vermian atrophy. Significantly higher serum (S) levels of bilirubin, gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (ASAT), alanine amino-transferase (ALAT), creatine kinase (CK), lactate dehydrogenase (LD) and amylase were found in IIB. The results indicate that drug use influences the incidence of cortical and subcortical aberrations, except anterior horn index. It is concluded that the groups with alcohol abuse who used hepatotoxic drugs showed a picture of cortical changes (wide transport sulci and clear-cut or high-grade cortical changes) and also of subcortical aberrations, expressed as an increased widening of the third ventricle.