Methanol Intoxication on Magnetic Resonance Imaging – Case Reports

Czech version

Authors: M. Vaněčková ¹; S. Zakharov ²; J. Klempíř ³; E. Růžička ³; O. Bezdíček ³; I. Lišková ³; P. Diblík ⁴; M. Miovský ⁵; J. A. Hubáček ⁶; P. Urban ²; P. Ridzoň ²; D. Pelclová ²; Andrea Burgetová ¹ ; M. Mašek ¹; Z. Seidl ¹
Authors‘ workplace: Oddělení MR, Radiodiagnostická klinika 1. LF UK a VFN v Praze ¹; Klinika pracovního lékařství 1. LF UK a VFN v Praze ²; Neurologická klinika 1. LF UK a VFN v Praze ³; Oční klinika 1. LF UK a VFN v Praze ⁴; Klinika adiktologie 1. LF UK a VFN v Praze ⁵; Centrum experimentální medicíny, IKEM, Praha ⁶
Published in: Cesk Slov Neurol N 2014; 77/110(2): 235-239
Category: Case Report

Práce byla podpořena výzkumným záměrem RVO-VFN64165, 0021620849, projektem PRVOUK- P26/LF1/4, P25/1LF/2 a projektem (Ministerstva zdravotnictví) rozvoje výzkumné organizace 00023001 (IKEM) – Institucionální podpora, projektem „Prospektivní studie dlouhodobých zdravotních následků akutních intoxikací methanolem“ v rámci programu Národní akční plány a koncepce 2013 MZ ČR (rozhodnutí č. OZS/36/4142/2013).

Overview

Methanol is a highly toxic liquid with affinity to optic nerves and the central nervous system. Poisoning can occur during a suicide attempt or as a result of an accident, most often due to mistaking methanol for alcohol. In the Czech Republic, the so called methanol affair still resonates; a total of 121 patients were hospitalized due to intoxication with methanol. We present three cases, their magnetic resonance imaging results and residual clinical disability. Methanol intoxication leads to metabolic acidosis and permanent sequelae such as blindness, permanent neurological disability (especially extrapyramidal disorders) and, in severe cases, the patient’s death. Magnetic resonance imaging shows a methanol intoxication-specific finding; during an acute phase, it may be useful in differential diagnosis as well as for predicting severity of disability and subsequent course of clinical condition. The finding on imaging gradually evolves. Typically, magnetic resonance depicts bilateral necrosis in the putamen with or without signs of bleeding. Another typical localization is the subcortical area; findings in the stem and the cerebellum or other basal ganglia are less frequent. On examination of the visual pathway, an atrophy of optic nerve can be detected; demyelination is present during the acute phase.

Key words:
methanol – intoxication – magnetic resonance imaging – basal ganglia

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Zakharov S, Pelclová D, Navrátil T, Fenclová Z, Petrik V. Hromadná otrava metanolem v České republice v roce 2012: srovnání s „metanolovými epidemiemi“ v jiných zemích. Urgent Med 2013; 16(2): 25– 29.

2. Arora V, Nijjar IBS, Multani AS, Singh JP, Abrol R, Chopra R et al. MRI finding in metanol intoxication: a report of two cases. Brit J Radiol 2007; 80(958): e243– e246.

3. Blanco M, Casado R, Vázque F, Pumar JM. CT and MR imaging findings in methanol intoxication. AJNR Am J Neuroradiol 2006; 27(2): 452– 454.

4. Gaul HP, Wallace CJ, Auer RN, Fong TC. MR findings in metanol intoxication. AJNR Am J Neuroradiol 1995; 16(9): 1783– 1786.

5. Singh P, Paliwal VK, Neyaz Z, Kanaujia V. Methanol toxicity presenting as haemorrhagic putaminal necrosis and optic atrophy. Pract Neurol 2013; 13(3): 204– 205. doi: 10.1136/ practneurol‑ 2012– 000500.

6. Folstein MF, Folstein SE, McHugh PR. „Mini‑mental state“. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189– 198.

7. Sharma P, Eesa M, Scott JN. Toxic and Acquired Metabolic Encephalopathies: MRI appearence. AJR Am J Roentgenol 2009; 193(3): 879– 886. doi: 10.2214/ AJR.08.2257.

8. Sefidbakht S, Rasekhi AR, Kamali K, Borhani Haghighi A, Salooti A, Meshksar A et al. Methanol poisoning: acute MR and CT findings in nine patients. Neuroradiology 2007; 49(5): 427– 435.

9. Server A, Hovda KE, Nakstad PH, Jacobsen D, Dullerud R, Haakonsen M. Conventional and diffusion‑ weighted MRI in the evaluation of metanol poisoning. Acta Radiologica 2003; 44(6): 691– 695.

10. Bhatia R, Kumar M, Garg A, Nanda A. Putaminal necrosis due to metanol toxicity. Pract Neurol 2008; 8(6): 386– 387. doi: 10.1136/ jnnp.2008.161976.