Citation, DOI & case data
Unconscious patient with metabolic acidosis (pH 6.8) His partner said she found him unconscious, with a funny smell (he might have drunk something toxic)
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Axial contrast CT.
Diffuse cerebral edema with sulcal effacement.
Bilateral and symmetric putaminal hypodensity, that probably reflects acute putaminal necrosis.
8 hours before, a non-contrast brain CT was performed, which didn't show putaminal damage.
Methanol poisoning must be suspected in unconscious patients with severe uncompensated metabolic acidosis. It typically leads to bilateral putaminal necrosis, seen as bilateral hypo-attenuation on CT images and/or putaminal hemorrhage.