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

Yıl 2024, Cilt: 13 Sayı: 1, 223 - 226, 20.03.2024

Adil Aytaç , Erdoğan Bülbül , Bahadir Çağlar

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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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