CMAJ • February 27, 2007; 176 (5). doi:10.1503/cmaj.060647.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Almansori, M.
Right arrow Articles by Ahmed, S. N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Almansori, M.
Right arrow Articles by Ahmed, S. N.
Related Collections
Right arrow Suicide
Right arrowRelated Articles

Clinical Vistas Briefs

CT findings in methanol intoxication

Mohammed Almansori* and S. Nizam Ahmed{dagger}

*Department of Internal Medicine; {dagger}Department of Neurology, University of Alberta, Edmonton, Alta.

What's your call?


Figure 12
Figure. Head CT scans of an unconscious 42-year-old man, taken 48 hours after admission to hospital after an attempted suicide.


The patient had attempted suicide by consuming methanol. On admission, his methanol level was 46 (normal < 2) mmol/L. He was unconscious, with generalized rigidity, exaggerated muscle stretch reflexes, and bilateral clonus and extensor plantar responses. CT scans of the brain obtained 48 hours after admission to hospital showed symmetric areas of low attenuation in the peripheral white matter of both cerebral hemispheres bordered by the grey-white junction, involving both frontal, parietal occipital and temporal lobes (Fig. 1, small arrows). Symmetric hypointensities were also noted in both lentiform nuclei, centred within the putamen and extending into the external capsules (Fig. 1, bold arrow).


Figure 112
View larger version (104K):
[in this window]
[in a new window]

  		Fig. 1: CT scan showing symmetrical areas of low attenuation in the peripheral white matter (small arrows) and symmetrical hypointesities in both lentiform nuclei (bold arrow).

 

Mechanical ventilation, hemodialysis and intravenous ethanol therapy were begun, with no significant improvement in clinical status. Nine days after admission, the patient died of respiratory failure after his family decided to withdraw ventilatory support.

Methanol has a toxic effect on the central nervous system, especially the optic nerves and the basal ganglia. Symmetric involvement of the basal ganglia is the most characteristic radiologic feature of methanol poisoning.1 However, certain other conditions must be kept in mind in the differential diagnosis, such as carbon monoxide intoxication,2 striatonigral degeneration, anoxic stroke and Wilson's disease.3 Although bilateral involvement of the basal ganglia on CT scans is a characteristic finding of methanol intoxication, it is infrequently seen in clinical practice.


*    Footnotes
 
Competing interests: None declared.



*    REFERENCES
Top
 REFERENCES
 

  1. Aquilonius SM, Askmark H, Enoksson P, et al. Computerized tomography in severe methanol intoxication. BMJ 1978;2:929-30.[Free Full Text]
  2. Silver DA, Cross M, Fox B, et al. Computed tomography of the brain in acute carbon monoxide poisoning. Clin Radiol 1996;51:480-3.[CrossRef][Medline]
  3. Starosta-Rubinstein S, Young AB, Kluin K, et al. Clinical assessment of 31 patients with Wilson's disease. Correlations with structural changes on magnetic resonance imaging. Arch Neurol 1987;44:365-70.[Abstract/Free Full Text]

Related Articles

Highlights of this issue
Can. Med. Assoc. J. 2007 176: 605. [Full Text] [PDF]

Dans ce numéro
Can. Med. Assoc. J. 2007 176: 605. [Full Text] [PDF]



eLetters:

Read all eLetters

Formic acid in methanol poisoning
Heikki Savolainen
CMAJ, 9 Mar 2007 [Full text]
This Article
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Almansori, M.
Right arrow Articles by Ahmed, S. N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Almansori, M.
Right arrow Articles by Ahmed, S. N.
Related Collections
Right arrow Suicide
Right arrowRelated Articles