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Erschienen in:
25.01.2016 | Neuro-Images
Teaching neuroimages: ‘Blind drunk’: neuroimaging findings in methanol poisoning
Erschienen in: Acta Neurologica Belgica | Ausgabe 4/2016
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A 34-year-old male presented to the emergency room in a confused state with visual loss following methanol intake. He rapidly progressed to coma requiring intubation. On examination, the patient was unresponsive with fixed dilated pupils, but other brain stem reflexes were present. Arterial blood gases showed pH 6.86, bicarbonate 6 mmol/l, anion gap elevated at 42 mmol/l and lactate 15 mmol/l. MRI is shown (Fig. 1). The patient had no improvement and died 1 week after admission. The putamen and optic nerves appear to be particularly susceptible to the effect of formic acid, the toxic metabolite of methanol, likely via interruption of mitochondrial function [1].
Fig. 1
MRI on day 4 shows extensive white matter and basal ganglia changes (a) on T2 and FLAIR images predominantly involving the putamen with peripheral hyperintensity consistent with the “lentiform fork” sign (b), findings typical of methanol poisoning [1, 2]. Diffusion weighed imaging shows diffusion restriction in the optic nerves bilaterally (c)
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