A Case Report of Putaminal Hemorrhage Due to Methanol Toxicity; is Hemodialysis the Offender?

Introduction: Methanol toxicity is a life-threatening condition which is rare in developed countries but common in developing countries. Bilateral putaminal necrosis and hemorrhage are potentially two lethal consequences of methanol toxicity which may be due to direct neurotoxicity of methanol metabolites, especially formic acid, or the consequences of acidosis and hypoxemia in the course of poisoning. Hemodialysis is an important part of the treatment of methanol toxicity and some researchers believe that heparin which is administrated during the hemodialysis may be the cause of putaminal hemorrhage Case report: We report a-۳۲-year old man who presented with acute symptoms of methanol toxicity. A day after hemodialysis he suffered from seizure and Parkinsonism, and the neuroimaging revealed bilateral putaminal hemorrhage. Treatment with Levodopa-carbidopa was introduced for the management of Parkinsonism and finally the patient was discharged with marked improvement of symptoms and relative independency in daily activities Discussion and Conclusion: Our patient suffered from a late manifestation of methanol intoxication, bilateral putaminal hemorrhage, and necrosis. This appearance along with subcortical white matter involvement are the most common abnormalities of methanol toxicity in the brain imaging which can be associated with peripheral enhancement. Based on the reported case and review of present evidences, it is suggested that putaminal hemorrhage in methanol toxicity can be due to anticoagulant agents used in hemodialysis  

Keywords:

Putamen hemorrhage , Toxicity , hemodialysis , Methanol