Citation

Maekawa N, Hoshiyama E, Suzuki K, Ono K. Neurol. India 2015; 63(6): 998-1000.

Affiliation

Department of Neurology, Dokkyo Medical University, Tochigi, Japan.

Copyright

(Copyright © 2015, Medknow Publications)

DOI

10.4103/0028-3886.170099

PMID

26588653

Abstract

A 42-year-old man with a history of depression and previous suicidal attempt was found lying in his living room and was transferred to our hospital. On initial examination, the patient's body temperature was 36.4°C, and he was in a deep coma. Arterial blood gas analysis revealed severe metabolic acidosis with increased levels of blood lactate and an anion gap. Diffusion-weighted [Figure 1a] and T2-weighted magnetic resonance images (MRI) [Figure 1b] detected hyperintensities in the brainstem and bilateral basal ganglia, thalami, and cerebral cortices with a restricted diffusion pattern on apparent diffusion coefficient maps [Figure 1c]. The MRI findings, negative urine tests for various drugs, and a previous history of suicidal attempt suggested that he had ingested ethylene glycol in another attempt to commit suicide. Despite ethanol infusion therapy, the brain edema, pneumonia, and renal failure progressed and the patient expired on day 16. The postmortem examination showed tubular necrosis with calcium oxalate crystal deposition, findings that are highly suggestive of ethylene glycol poisoning.

In patients with ethylene glycol ingestion, necrosis of the white matter, predominantly in the frontal lobe, basal ganglia, thalami, midbrain, and upper pons has been reported.[1] In addition, MRI changes related to ethylene glycol ingestion, including bilateral putaminal necrosis [2] and bilateral enhancement of the fifth cranial nerves with communicating hydrocephalus,[3] have been described. Although the brain computed tomography findings associated with ethylene glycol ingestion have been well-documented, there are very few case reports that describe the brain MRI findings associated with ethylene glycol intoxication. Signal changes predominantly seen in the dorsal pons may suggest the regional changes in a susceptible region due to ethylene glycol intoxication.

Language: en