Methanol-Induced Encephalopathy: a Case Report

A characteristic imaging finding in cases of methanol intoxication is putaminal necrosis, but its presence is usually not suspected due to its rarity. Methanol intoxication generally produces serious neurological symptoms that include visual disturbances and diminished consciousness, characteristically with metabolic acidosis. We reported the case of a 59-year-old man who was admitted to the hospital with diminished consciousness. Acute methanol intoxication was determined as the cause. Laboratory tests revealed high anion gap metabolic acidosis. Diffusion-weighted MRI indicated diffuse symmetric diffusion restriction lesions in the subcortical white matter of both cerebral hemispheres.

Methanol Intoxication With Delayed Extensive Bilateral Subcortical Hemorrhage

The most characteristic radiological finding following methanol intoxication is bilateral necrosis of the putamina with varying degrees of hemorrhage. We report here on a 61-year-old Russian male with methanol intoxication who had delayed cerebral hemorrhage with a fatal course. The magnetic resonance image taken on admission revealed diffusion restriction lesions in the bilateral putamina, thalamus, and frontal and occipital subcortical white matter, without hemorrhage. Brain computed tomography performed on the 18th day revealed extensive bilateral hemorrhage in the multiple subcortical white matter, which led ultimately to death.

A Case of Methanol Intoxication with Multifocal Enhancing Lesions in Brain Magnetic Resonance Imaging

In accidental or suicidal methanol ingestion, bilateral necrosis of the putamen and hemispheric white matter lesions are the most common findings on CT and MRI. There are a few reports that have demonstrated abnormal CT findings in methanol intoxication, however, to our knowledge, contrast enhancement of these lesions have not been reported in Korea. We report the case of a 36-year-old male who had a brain MRI performed 3 weeks after accidental methanol intoxication. T2 weighted MRI showed bilateral symmetrical high signal lesions in the frontal lobe and basal ganglia with hemorrhaegic necrosis. A postcontrast MRI demonstrated multifocal enhancing lesions in both frontal lobes, right temporal lobe, both basal ganglias and both cerebellar hemispheres. We suggest that the characteristic brain MRI finding and careful history taking are helpful in diagnosis of methanol intoxication.