Acute methanol poisoning with bilateral diffuse cerebral hemorrhage: A case report

Abstract

Background: Acute methanol poisoning (AMP) is a systemic disease that mainly affects the central nervous system and is characterized by ocular damage and metabolic acidosis. If appropriate treatments are inadequate or delayed, the mortality can exceed 40%. As the most serious complication, cerebral hemorrhage is rare with reported prevalence of 7%-19%.

Case summary: A 62-year-old man drank liquor mixed with 45% methanol and 35% alcohol. His vision blurred 10 h later and he fell into coma in another 9 h. Serum toxicological tests were performed immediately, and continuous renal replacement therapy (CRRT) was carried out as the lactic acid exceeded 15 mmol/L and blood pH was 6.78. In addition, the toxicological report revealed 1300.5 μg/mL of methanol in serum and 1500.2 μg/mL in urine. After 59 h of CRRT, the methanol level decreased to 126.0 μg/mL in serum and 151.0 μg/mL in urine. However, the patient was still unconscious and his pupillary light reflex was slow. Computed tomography showed hemorrhage in the left putamen. After 16 d of life support treatment, putamen hemorrhage developed into diffuse symmetric intracerebral hemorrhage. In the end, his family gave up and the patient was discharged, and died in a local hospital.

Conclusion: Cerebral hemorrhage requires constant vigilance during the full course of treatment for severe cases of AMP.

Keywords: Acute methanol poisoning; Case report; Cerebral hemorrhage; Hemodialysis; Toxicity.

Figure 1

Schematic diagram of methanol metabolism. ADH: Alcohol dehydrogenase; FDH: Formaldehyde dehydrogenase.

Figure 2

Chest computed tomography. A: Diffuse exudation in the lungs; B: Exudation in the lungs was significantly cleared up. Imaging A and B were performed at an interval of approximate 3 h for excluding pulmonary embolism and aortic dissection.

Figure 3

Head computed tomography. A: On February 16, 2021 when the patient was in the Emergency Department, there was slight symmetrical decrease in density in the bilateral putamen but no sign of hemorrhage; B: On February 19 after the first course of continuous renal replacement therapy, there was an area of hemorrhage 1.5 cm × 0.5 cm in the left putamen (black arrows) and bilateral confluent symmetrical hypodensity in bilateral brain parenchyma (white arrows); C: On March 6, there was diffuse symmetric intracerebral hemorrhage (black arrows).