Neurotoxic overdose in a young man: answer

Abstract

The man’s initial serum methanol level was found to be 231 mmol/L. The methanol level quickly responded to treatment, and was undetectable after 36 hours. One week after extubation, he was severely rigid and bradykinetic with significant weakness in his upper and lower extremities. He had also suffered severe visual impairment from retinal toxicity. Two months later, with the benefit of aggressive physiotherapy, he was ambulating with minimal assistance and a two wheeled walker, and had 4/5 gross motor strength in both his upper and lower extremities. Methanol poisoning is relatively uncommon, but carries a high mortality rate [1]. Ingested methanol is metabolized into formaldehyde and then formic acid by alcohol and formaldehyde dehydrogenases, respectively. The hallmarks of methanol poisoning are an anion gap metabolic acidosis and visual impairment. Formate causes demyelination and necrosis to the optic nerve and may cause permanent damage in 11–18% of patients [1,2]. Although rare, putamen necrosis has been previously documented in methanol toxicity [3–6]. Affected patients may exhibit rigidity,