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|Year : 2015 | Volume
| Issue : 6 | Page : 998-1000
Brain magnetic resonance image changes following acute ethylene glycol poisoning
Nana Maekawa1, Eisei Hoshiyama2, Keisuke Suzuki2, Kazuyuki Ono1
1 Emergency and Critical Care Medical Center, Dokkyo Medical University, Tochigi, Japan
2 Department of Neurology, Dokkyo Medical University, Tochigi, Japan
|Date of Web Publication||20-Nov-2015|
Dr. Keisuke Suzuki
Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maekawa N, Hoshiyama E, Suzuki K, Ono K. Brain magnetic resonance image changes following acute ethylene glycol poisoning. Neurol India 2015;63:998-1000
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 1]a and T2-weighted magnetic resonance images (MRI) [Figure 1]b detected hyperintensities in the brainstem and bilateral basal ganglia, thalami, and cerebral cortices with a restricted diffusion pattern on apparent diffusion coefficient maps [Figure 1]c. 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.
|Figure 1: Diffusion-weighted (a) and T2-weighted (b) images show hyperintensities in the brainstem and bilateral basal ganglia, thalami, and cerebral cortices. Apparent diffusion coefficient maps (c) show a restricted diffusion pattern|
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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. In addition, MRI changes related to ethylene glycol ingestion, including bilateral putaminal necrosis  and bilateral enhancement of the fifth cranial nerves with communicating hydrocephalus, 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.
The differential diagnoses of bilateral involvement of the basal ganglia and thalami include cerebrovascular diseases such as deep cerebral venous thrombosis and arterial occlusion, liver diseases such as hepatic cirrhosis with portal hypertension or hyperammonemia, nonketotic hyperglycemia, hypoglycemia, hypoxic ischemic encephalopathy, extrapontine myelinolysis, Wernicke encephalopathy, Creutzfeldt–Jakob disease, Fahr's disease, Neuro-Behçet's disease, cerebral toxoplasmosis, and primary central nervous system lymphoma. Bilateral abnormalities of the basal ganglia and thalami should also prompt a screening for toxic poisoning, including that of ethylene glycol.
We thank Dr. Shigeko Kuwashima, Department of Radiology, Dokkyo Medical University, Dr. Toshiki Nakamura, Department of Neurology, Rehabilitation Amakusa Hospital and Dr. Akira Kurosu, Department of Legal Medicine, Dokkyo Medical University for their helpful suggestions with regard to this patient.
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Conflicts of interest
There are no conflicts of interest.
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