What is the role of MRI in the workup of methanol toxicity?

Updated: Nov 05, 2018
  • Author: Kalyani Korabathina, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

A characteristic finding is bilateral putaminal necrosis with or without hemorrhage, probably as a result of the direct toxic effects of methanol metabolites. This finding is certainly not specific for methanol toxicity, because it can be seen with other diseases, such as Wilson disease, Leigh disease, and stroke. [20]

Other findings that have been described include cerebral and intraventricular hemorrhage, diffuse cerebral edema, cerebellar necrosis, subcortical white matter necrosis, optic nerve necrosis, and even enhancement of necrotic lesions. [20]

In a series of 4 patients, MRI performed within 2 weeks of methanol intoxication demonstrated changes in the putamen of all 4 patients. [21] Three of these patients had white matter lesions within the occipital/frontal lobes. Interestingly, in patients who recovered without extrapyramidal symptoms, the lesions regressed within several weeks. The authors recommend MRI as a prognostic tool and as a means of differentiating methanol intoxication from other conditions, such as hypoglycemia and carbon monoxide poisoning.


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