|
 
 |
| CASE REPORT |
|
| Year : 2013 | Volume
: 5
| Issue : 10 | Page : 623-624 |
|
Bilateral putaminal hemorrhages: Serious complication of methanol intoxication
Nitipong Permpalung, Wisit Cheungpasitporn, Daych Chongnarungsin, Travis M Hodgdon
Department of Medicine, Bassett Medical Center, Cooperstown, New York, USA
| Date of Web Publication | 30-Oct-2013 |
Correspondence Address:
Wisit Cheungpasitporn
Department of Medicine, Bassett Medical Center, Cooperstown, New York - 13326
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1947-2714.120804
Context: Methanol intoxication is a life-threatening condition. Hallmark of clinical presentations include severe wide anion gap metabolic acidosis with very high serum osmolar gap and visual complication. Case Report: We report a case of severe methanol intoxication with bilateral putaminal hemorrhage, an uncommon serious complication. A 56-year-old man presented with altered mental status. Fundus examination showed optic disc edema. Arterial Blood Gas (ABG) revealed severe anion gap metabolic acidosis with osmolal gap. Head computed tomography (CT) showed hypodense lesions in basal ganglia bilaterally. Hemodialysis and intravenous fomepizole were initiated. Serum methanol level was significantly elevated. Unfortunately, patient was lethargic 2 weeks after discharge. Repeated CT of head demonstrated new putaminal hemorrhages. Conclusion: Bilateral putaminal hemorrhage is an uncommon but serious complication in methanol intoxication. Clinicians should have high index of suspicion for putaminal hemorrhage when patients with recent methanol intoxication present with altered mental status. Keywords: Basal ganglion hemorrhage, Metabolic acidosis, Methanol intoxication, Putaminal hemorrhage
How to cite this article:
Permpalung N, Cheungpasitporn W, Chongnarungsin D, Hodgdon TM. Bilateral putaminal hemorrhages: Serious complication of methanol intoxication. North Am J Med Sci 2013;5:623-4 |
How to cite this URL:
Permpalung N, Cheungpasitporn W, Chongnarungsin D, Hodgdon TM. Bilateral putaminal hemorrhages: Serious complication of methanol intoxication. North Am J Med Sci [serial online] 2013 [cited 2022 Jun 26];5:623-4. Available from: https://www.najms.org/text.asp?2013/5/10/623/120804 |
| Introduction | |  |
Methanol or wood alcohol is commonly found as a component of household products including paint removers or windshield washer fluid. Due to catastrophic consequences of methanol consumption, it cannot be used as an alcohol beverage. We report a case of middle aged man presented with confusion, severe metabolic acidosis secondary to methanol intoxication. A repeat CT scan of brain revealed bilateral putaminal hemorrhage as a late complication of methanol poisoning.
| Case Presentation | | |
A 56-year-old man with history of episodic alcohol abuse and rectal adenocarcinoma status post-surgery and neoadjuvant chemoradiation therapy presented to emergency department with altered mental status. On admission, he was comatose with dilated pupils and minimal reaction to light. Fundus examination showed optic disc edema without evidence of retinal hemorrhage. Arterial Blood Gas (ABG) revealed severe metabolic acidosis; pH 6.89, pCO 2 13, pO 2 178, HCO 3 < 3. Blood tests also demonstrated anion gap and osmolal gap. Head computed tomography (CT) showed new hypodense lesions in basal ganglia bilaterally and old small vessel ischemia changes in periventricular matter [Figure 1]a. | Figure 1: (a) Head computed tomography (CT) showed new hypodense lesions in basal ganglia bilaterally and old small vessel ischemia changes in periventricular matter. (b) New CT of head without contrast demonstrated new hyperdensities in putaminal area compatible with the diagnosis of putaminal hemorrhages
Click here to view |
Emergent hemodialysis (HD) and treatment with intravenous fomepizole were initiated. Serum methanol level, obtained after hemodialysis, came back significantly elevated. Ophthalmologist was consulted for visual defect and diagnosed the patient with legal blindness without other focal neurological deficit prior to discharge. Type of alcohol, consumed by the patient, was still unknown. Unfortunately, patient developed confusion and lethargy 2 weeks after discharge. New CT of head without contrast demonstrated new hyperdensities in putaminal area compatible with the diagnosis of putaminal hemorrhages [Figure 1]b.
| Discussions | | |
Methanol intoxication is a life-threatening condition. Bilateral putaminal hemorrhages, complication carrying very high morbidity, have been described in methanol intoxication and can be found in other diseases including inborn error metabolism, renal failure with severe metabolic acidosis, and ethylene glycol intoxication. [1],[2] The proposed underlying mechanism is acid-induced neural cell death. [3] In addition to putaminal hemorrhage, another important complication is visual loss. The mechanism is currently presumed to be formic acid-induced retinal damage from animal models. [4] There are no studies conducted in human for the pathophysiology of methanol optic neuropathy. There was one recent research demonstrating the role of intravenous erythropoietin with oral prednisolone to improve a visual acuity in the patients with optic neuropathy. [5]
Our case presentation demonstrates that even appropriate treatment, promptly initiated. The patient still developed putaminal hemorrhage. Clinicians should have high index of suspicion for putaminal hemorrhage when patients with recent methanol intoxication present with alter mental status, confusion or behavioral change.
| References | | |
| 1. | Martínez Bermejo A, Arcas J, Roche MC, López-Martín V, Royo A, Merinero B, et al. Bilateral hypodensity of the basal ganglia. Clinico-evolutionary correlation in children. Rev Neurol 2001;33:101-11. 
|
| 2. | Corr P, Szólics M. Neuroimaging findings in acute ethylene glycol poisoning. J Med Imaging Radiat Oncol 2012;56:442-4.
|
| 3. | Sherwood TW, Lee KG, Gormley MG, Askwith CC. Heteromeric acid-sensing ion channels (ASICs) composed of ASIC2b and ASIC1a display novel channel properties and contribute to acidosis-induced neuronal death. J Neurosci 2011;31:9723-34.
|
| 4. | Chen JM, Zhu GY, Xia WT, Zhao ZQ. Proteomic analysis of rat retina after methanol intoxication. Toxicology 2012;293:89-96.
|
| 5. | Pakravan M, Sanjari N. Erythropoietin treatment for methanol optic neuropathy. J Neuroophthalmol 2012;32:325-8.
|
[Figure 1]
| This article has been cited by | | 1 |
Unusual case of spontaneous bilateral basal ganglia bleed |
|
| Jessica Kayastha, Pravesh Rajbhandari, Pritam Gurung, Bishal Shrestha, Sambardhan Dabadi, Basant Pant | | Clinical Case Reports. 2022; 10(2) | | [Pubmed] | [DOI] | | | 2 |
Spontaneous Simultaneous Bilateral Basal Ganglia Hemorrhage (SSBBGH): Systematic Review and Data Analysis on Epidemiology, Clinical Feature, Location of Bleeding, Etiology, Therapeutic Intervention and Outcome |
|
| Ali Alhashim, Kawther Hadhiah, Hassan Al-Dandan, Mugbil Aljaman, Majed Alabdali, Mohammed Alshurem, Danah Aljaafari, Mustafa AlQarni | | Vascular Health and Risk Management. 2022; Volume 18: 267 | | [Pubmed] | [DOI] | | | 3 |
Replacing methanol with azeotropic ethanol as the co-solvent for improved chiral separations with supercritical fluid chromatography (SFC) |
|
| Daipayan Roy,M. Farooq Wahab,Mohsen Talebi,Daniel W. Armstrong | | Green Chemistry. 2020; | | [Pubmed] | [DOI] | | | 4 |
Sonochemical production of hydrogen: A numerical model applied to the recovery of aqueous methanol waste under o
xygen-argon
atmosphere |
|
| Kaouther Kerboua,Oualid Hamdaoui,Saeed Al-Zahrani | | Environmental Progress & Sustainable Energy. 2020; | | [Pubmed] | [DOI] | | | 5 |
Inpatient Burden and Mortality of Methanol Intoxication in the United States |
|
| Wisit Kaewput,Charat Thongprayoon,Tananchai Petnak,Api Chewcharat,Boonphiphop Boonpheng,Tarun Bathini,Saraschandra Vallabhajosyula,Wisit Cheungpasitporn | | The American Journal of the Medical Sciences. 2020; | | [Pubmed] | [DOI] | | | 6 |
Spectrum of MRI findings in 58 patients with methanol intoxication: Long-term visual and neurological correlation |
|
| Sahar M. Elkhamary,Dalia M. Fahmy,Alberto Galvez-Ruiz,Nasira Asghar,Thomas M. Bosley | | The Egyptian Journal of Radiology and Nuclear Medicine. 2016; | | [Pubmed] | [DOI] | | | 7 |
Simultaneous bilateral hypertensive basal ganglia hemorrhage |
|
| Jingwang Zhao,Zhijuan Chen,Zengguang Wang,Qing Yu,Weidong Yang | | Neurologia i Neurochirurgia Polska. 2016; | | [Pubmed] | [DOI] | | | 8 |
Delayed high anion gap metabolic acidosis after a suicide attempt: Case report |
|
| Po-Jen Hsiao,Tsu-Yi Chen,Chih-Chien Chiu,Tsung-Jui Wu,Jenq-Shyong Chan,Chia-Chao Wu,Jin-Shuen Chen | | Clinica Chimica Acta. 2014; 436: 329 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
Search Pubmed for