A Case Report of Toxic Brain Syndrome Caused by Methyl Bromide

Abstract

Methyl bromide (CH3Br) is a halogenated aliphatic hydrocarbon that may cause acute and chronic toxicities. We describe a case of a 44-year-old male patient who developed toxic brain syndrome (TBS) and central nervous system (CNS) toxicity after exposure to CH3Br by inhalation. Toxicity began with progressive nervousness, dysarthria and coordination disorder. The complaints on admission to the hospital were speech defect, balance disorder, consciousness disorder and involuntary movements. The patient was treated symptomatically in the intensive care unit (ICU), and organic reasons were excluded. Findings in the magnetic resonance imaging were considered secondary demyelination related to systemic intoxication. Because of the CH3Br, alkylates the crucial sulfhydryl-containing enzymes, N-acetylcysteine was used as a source of sulfhydryl groups for the treatment of the patient. He was hospitalised for nearly 1.5 months in the ICU.

Keywords: Methyl bromide; central nervous system toxicity; poisoning.

Figure 1

Axial fluid-attenuated inversion recovery (FLAIR) images show increased signal intensity in the regions of the medulla oblongata, posterior pons and posterior mesencephalon, bilateral dentate nuclei of cerebellum and splenium of the corpus callosum

Figure 2

After 17 days, axial fluid-attenuated inversion recovery (FLAIR) images show normal signal intensity in the medulla oblongata, pons, mesencephalon and dentate nuclei but increased signal intensity in the cerebral peduncles. Increased signal intensity in the splenium of the corpus callosum is continued