Neuroimaging Patterns of Recreational Drug Use in the Emergency Setting

Recreational substance use is a global public health problem associated with preventable morbidity and mortality. Commonly consumed substances include alcohol, cannabinoids, opioids, benzodiazepines, amphetamines, cocaine, and inhalants. Given its prevalence in the emergency department, radiologists can expect to see neuroimaging manifestations of recreational drug use. Central nervous system imaging findings associated with recreational drug use vary widely depending on the drug of choice, the route of consumption, and the presence of impurities. Findings can be acute or chronic and include cerebrovascular, toxic and metabolic, and infectious entities. Cerebrovascular complications include structural and functional abnormalities that compromise intracranial perfusion. Toxic and metabolic entities are a diverse group of diseases that can be divided into alcohol-related complications, opioid toxidromes, and other toxic leukoencephalopathies. Infectious complications are associated with intravenous drug use and include bacterial infections, HIV-related diseases, and opportunistic infections. Radiologists interpreting emergency neuroimaging examinations are encouraged to be familiar with the broad spectrum of these findings because prompt recognition and communication are critical for optimal therapeutic management and accurate prognostication in this demographic. Supplemental material is available for this article. ^©RSNA, 2026.