Hsieh F Y, Leu T M, Chia L G
Division of Neurology, Taichung Veterans General Hospital, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1992 Apr;49(4):283-8.
Bilateral putaminal necrosis is characteristic of methanol poisoning. A 31-year-old male alcoholic had headache, impaired consciousness, neck stiffness, roving eyes with dilated unreactive pupils, papilloedema, abdominal pain, vomiting, and severe metabolic acidosis after a binge. Abnormalities of the cerebrospinal fluid included an initial pressure of 240 mmH2 O, RBC 286/mm3, WBC 8/mm3, and protein 179 mg/dl. Peritoneal dialysis was performed on the 2nd day after drinking. A blood test for methanol was not performed until the 5th day, and its results was negative. However, computed tomography (CT) on the 3rd day showed necrosis and hemorrhage of bilateral putamina and the cerebral cortex, and post-contrast enhancement of meninges. On the 22nd day, a CT revealed further changes: necrosis of bilateral subcortical white matter, and post-contrast gyral enhancement at the otherwise normal-looking areas of the cerebral cortex. We suggest that, in certain situations, the characteristic CT findings are helpful in the diagnosis of methanol poisoning.
双侧壳核坏死是甲醇中毒的特征性表现。一名31岁的男性酗酒者在一次狂饮后出现头痛、意识障碍、颈部僵硬、眼球游动且瞳孔散大固定、视乳头水肿、腹痛、呕吐及严重代谢性酸中毒。脑脊液异常包括初始压力240 mmH2O、红细胞286/mm3、白细胞8/mm3及蛋白179 mg/dl。饮酒后第2天进行了腹膜透析。直到第5天才进行甲醇血液检测，结果为阴性。然而，第3天的计算机断层扫描（CT）显示双侧壳核及大脑皮质坏死和出血，脑膜造影后强化。第22天，CT显示进一步变化：双侧皮质下白质坏死，大脑皮质外观正常区域的脑回造影后强化。我们认为，在某些情况下，特征性的CT表现有助于甲醇中毒的诊断。
