Presentation
Patient with a history of chronic alcohol abuse presents with vision loss, sharp headache, nausea and photophobia.
Patient Data
CT of the head displays symmetric hypodensity in the bilateral putamina as well as the right caudate nucleus.
MRI of the brain and orbits displays symmetric hyperintensity on T2/FLAIR within the bilateral putamina with associated atrophy suggestive of necrosis. Additionally, hyperintensity on T2/FLAIR is seen in the right caudate and right greater than left medial cerebral peduncles. There are also subtle punctate foci of hyperintensity on T2/FLAIR in the left greater than right lateral medulla and dorsal pons. There is no corresponding diffusion restriction, susceptibility or enhancement.
MRI of the orbits displays atrophy of the bilateral optic nerves. There is also probable hyperintensity on T2WI centrally within the optic chiasm and region of the optic tracks posteriorly through the lateral geniculate.
Case Discussion
This case displays the typical appearance of the chronic sequelae of methanol poisoning. Key features include the symmetric putaminal necrosis and optic nerve involvement.
Co-Author: Samantha Scott
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