Radiology Findings in a Case of Acute Methanol Intoxication Complicated with Intracranial Hemorrhage

Year 2024, , 223 - 226, 20.03.2024

Adil Aytaç , Erdoğan Bülbül , Bahadir Çağlar

https://doi.org/10.53424/balikesirsbd.1184383

Abstract

Objective: Methanol intoxication is rare and it can be fatal. This case report aimed to describe the radiological findings in acute methanol intoxication complicated with intracranial haemorrhage in a young patient. A 32-year-old man applied to emergency department with a major complaint of nausea, vomiting, double vision, and confusion. Glascow coma score (GCS) was 7 at the initial referral. Laboratory tests showed high anion gap metabolic acidosis. Acute methanol intoxication was diagnosed by aid of the patient anamnesis. Diffusion-weighted MRI (DW-MRI) showed similar diffusion restriction lesions in the putamen and cingulate gyrus of both cerebral hemispheres. The patient had a cardiac arrest during follow-up in the emergency department. He was converted to sinus rhythm with the interventions, intubated, and taken to the intensive care unit. GCS reduced to 3 during follow- up at the 4th day. Cerebral intraparenchymal haemorrhage at the level of left basal ganglia was observed in the brain computed tomography (CT). He was operated however remained comatose after the operation and died at the 8th day of admission. Possibility of methanol intoxication should be included in the differential diagnosis in patients with altered consciousness, vision disturbances and a high anion gap admitted to the emergency service. DW-MRI may be helpful in diagnosis by detecting symmetrical diffusion restrictions at the basal ganglia. Additionally radiologic methods like CT can be used to determine complications such as bleeding that may occur during the follow-up of the cases.

Keywords

: Methanol intoxication, Putamen, Diffusion restriction, MRI, Cerebral hemorrhage

İntrakraniyal Kanama ile Komplike olan Bir Akut Metanol İntoksikasyonu Vakasında Radyolojik Bulgular

Abstract

Amaç: Metanol intoksikasyonu nadir görülen bir antitedir ve ölümcül olabilir. Bu olgu sunumunda, intrakraniyal kanama ile komplike olan metanol intoksikasyonlu genç hastada radyolojik bulguların tanımlanması amaçlanmıştır. Otuz iki yaşındaki bir erkek hasta bulantı, kusma, çift görme ve bilinç bulanıklığı ana şikayetleri ile acil servise başvurdu. İlk başvuruda Glascow koma skoru (GKS) 7 idi. Laboratuvar testlerinde yüksek anyon açıklı metabolik asidoz görüldü. Hastanın anamnezi ile birlikte akut metanol intoksikasyonu tanısı konuldu. Difüzyon ağırlıklı MRG (DA-MRG) incelemesinde, her iki putamen ve singulat girusta benzer difüzyon kısıtlılığı görüldü. Hastanın acil servisteki takibi sırasında kardiyak arrest gelişti. Yapılan müdahalelerle sinüs ritmine döndürülüp, entübe edilerek yoğun bakıma alındı. Takibinin 4. gününde GKS 3’e düştü. Beyin bilgisayarlı tomografisinde (BT) sol bazal ganglion seviyesinde intraparankimal hematom izlendi. Hasta opere edildi ancak ameliyattan sonra da komada kaldı ve yatışının 8. gününde kaybedildi. Acil servise bilinç değişikliği, görme bozukluğu ile başvuran ve yüksek anyon açığı olan hastalarda metanol intoksikasyonu olasılığı ayırıcı tanıda yer almalıdır. DA-MRG’de, bazal ganglionlarda simetrik difüzyon kısıtlamaları görülmesi ayırıcı tanıda yardımcı olabilir. Ayrıca olguların takibinde oluşabilecek kanama gibi komplikasyonları belirlemek için BT gibi radyolojik yöntemler kullanılabilir.

Keywords

Metanol intoksikasyonu, Putamen, Difüzyon kısıtlılığı, MRG, Beyin kanaması

References

• Camurcuoglu E & Ahmet Mesrur Halefoglu (2022), CT and MR Imaging Findings in Methanol Intoxication Manifesting with BI Lateral Severe Basal Ganglia and Cerebral Involvement, Journal of the Belgian Society of Radiology. 2022; 106(1): 66, 1–4, doi: 10.5334/jbsr.2836
• DiPoce J & Guelfguat M (2012). Radiologic Findings in Cases of Attempted Suicide and Other Self-Injurious Behavior. Radiographics. 32(7):2005-24. https://doi.org/10.1148/rg.327125035
• Gök M, Özüm Tunçyürek, Ersen Ertekin &Yelda Özsunar Dayanır (2017), Imaging Findings for Methanol Intoxication, Kafkas J Med Sci 2017; 7(1):158–161, doi: 10.5505/kjms.2017.91259
• Hyun Jin Kim, Moon Kyung Sunwoo, Jang Han Lee , Yong Sun Choi & Dae Yoon Kim (2017), Methanol-Induced Encephalopathy: a Case Report, iMRI 2017;21:61-64, https://doi.org/10.13104/imri.2017.21.1.61
• Matthew P. Quinn, Lulu Bursztyn &Manas Sharma (2020) Putaminal Diffusion Restriction in a Case of Methanol Toxicity with Clinical Recovery, Canadian Journal of Neurological Sciences , Volume 47 , Issue 1 , January 2020 , pp. 115 – 116 DOI: https://doi.org/10.1017/cjn.2019.303
• Mehdi Mesri, Mohammad Javad Behzadnia & Mohammad Nikpoor et all (2021), Cerebral Methanol Intoxication: A Case Report with Literature Review, Canadian Journal of Medicine 3(2021) 195-201doi: 10.33844/cjm.2022.60611
• Nirdesh Jain, Dandu Himanshu, Shailendra Prasad & Verma,Anit Pariharb (2013), Methanol poisoning: characteristic MRI findings, Ann Saudi Med. 2013 Jan-Feb; 33(1): 68–69, doi: 10.5144/02564947.2012.26.5.1114
• Raisa Faizan, Ashok kumar & Imtiaz Ali Panhwar et all (2021), MRI brain, featuring methanol intoxication: a rare case report, December 2021;31 (4):247-249
• Rumita Kayastha, Riwaz Acharya & Subodh Shrestha (2022), MRI findings in a case of acute methanol intoxication, URL: https://www.eurorad.org/case/17772, doi: 10.35100/eurorad/case.17772, ISSN:1563-4086
• Sahar M. Elkhamary, Dalia M.fahmy & Alberto Galvez- Ruiz et all (2016), Spectrum of MRI findings in 58 patients with methanol intoxication: Long-term visual and neurological correlation, The Egyptian Journal of Radiology and Nuclear Medicine Volume 47, Issue 3, September 2016, Pages1049-1055, https://doi.org/10.1016/j.ejrnm.2016.06.011
• Zeinali M, Motamed MR & Almasi Dooghaee M (2021). A Case Report of Putaminal Hemorrhage Due to Methanol Toxicity; is Hemodialysis the Offender? Asia Pac J Med Toxicol 2021; 10(2):74-76. doi: 10.22038/APJMT.2021.18235