Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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January 19, 2017
Methanol Intoxication
- Background:
- Methanol metabolizes into formaldehyde and formic acid, leading to metabolic acidosis and neurologic damage.
- Clinical Presentation:
- Symptoms are dose-dependent.
- 12-24 hours following methanol ingestion (latent period)
- Initial symptoms include visual disturbances, dizziness, and headache.
- Large amount of ingestion could lead to seizures, stupor, and coma
- Key Diagnostic Features:
- Bilateral putaminal necrosis and hemorrhage
- Bilateral white matter edema/necrosis (subcortical white matter T2-hyperintensities)
- Cerebral and intraventricular hemorrhage
- Cerebellar necrosis
- Diffuse cerebral edema
- Optic nerve demyelination
- Differential Diagnoses:
- Hypertensive hemorrhage
- Carbon monoxide intoxication
- Leigh disease
- Wilson disease
- Treatment:
- For acute intoxication (less than 24 hours): ethanol administration to avoid metabolization of methanol by alcohol dehydrogenase enzyme
- Gastric lavage
- Correction of metabolic acidosis
Suggested Reading
- Blanco M, Casado R, Vázquez F, Pumar JM. CT and MR imaging findings in methanol intoxication. AJNR Am J Neuroradiol 2006;27:452–54
- Halavaara J, Valanne L, Setälä K. Neuroimaging supports the clinical diagnosis of methanol poisoning. Neuroradiology 2002;44:924–28, 10.1007/s00234-002-0855-2
- Rubinstein D, Escott E, Kelly JP. Methanol intoxication with putaminal and white matter necrosis: MR and CT findings. AJNR Am J Neuroradiol 1995;16:1492–94
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