Bilateral Putaminal Hemorrhages: Serious Complication of Methanol Intoxication
A 56-year-old man with history of episodic alcohol abuse and rectal adenocarcinoma status post-surgery and neoadjuvant chemoradiation therapy presented to emergency department with altered mental status. On admission, he was comatose with dilated pupils and minimal reaction to light. Fundus examination showed optic disc edema without evidence of retinal hemorrhage. Arterial Blood Gas (ABG) revealed severe metabolic acidosis; pH 6.89, pCO2 13, pO2 178, HCO3 < 3. Blood tests also demonstrated anion gap and osmolal gap. Head computed tomography (CT) showed new hypodense lesions in basal ganglia bilaterally and old small vessel ischemia changes in periventricular matter [].\nEmergent hemodialysis (HD) and treatment with intravenous fomepizole were initiated. Serum methanol level, obtained after hemodialysis, came back significantly elevated. Ophthalmologist was consulted for visual defect and diagnosed the patient with legal blindness without other focal neurological deficit prior to discharge. Type of alcohol, consumed by the patient, was still unknown. Unfortunately, patient developed confusion and lethargy 2 weeks after discharge. New CT of head without contrast demonstrated new hyperdensities in putaminal area compatible with the diagnosis of putaminal hemorrhages [].