Methanol intoxication with hemorrhagic necrosis

Case contributed by Naim Qaqish
Diagnosis certain


Drowsiness and methanol toxicity.

Patient Data

Age: 40 years
Gender: Male

Bilateral basal ganglia symmetrical mixed-signal abnormalities with diffusion restriction and signal drop-in gradient-echo images mainly involving the putamen and head of the caudate nucleus. 

Large bilateral frontal subcortical white matter signal abnormalities are also seen depicting diffusion restriction.

Small signal abnormalities are also seen in the occipital subcortical white matter.

Findings are indicating acute methanol intoxication with hemorrhagic necrosis in the basal ganglia.

Cerebellum and brain stem appear preserved.

Normal ventricular system and sulci

Case Discussion

This case illustrates bilateral basal ganglia involvement demonstrating water restriction on diffusion-weighted images and hyperintense signal on T1 indicating hemorrhagic necrosis. This patient present through the ER with methanol intoxication. Typical appearances of acute phase are illustrated by the involvement of the putamen with hemorrhagic necrosis and subcortical white matter of the frontal and occipital regions.

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