The spectrum of brain MRI findings of methanol intoxication after the methanol affair in the Czech Republic

Abstract

To demonstrate the variability of brain magnetic resonance imaging (MRI) findings in patients of acute methanol poisoning. A total of 51 patients were scanned an a 3T MAGNETOM Skyra scanner (Siemens Healthcare, Erlangen, Germany) with the same protocol. The MR protocol included 3D T1-weighted, 2D T2-weighted, fluid-attenuated inversion recovery, susceptibility-weighted imaging as well as coronal T2-weighted images with fat sat for visualization of the optic nerves. 3D T1-weighted images were processed using the MorphoBox prototype software yielding estimation of regional brain volumes. Imaging methods revealed a positive finding associated with methanol intoxication in 24 patients (47.1%), mostly seen as symmetrical lesions in the putamen, which afflicted 16 patients (31.4%) (Fig. 1). Haemorrhage was detected in 16 cases (31.4%), deposits in white matter with localisation primarily subcortically in 5 cases (9.8%), and lesions in the region of the pallidum in 7 cases (13.7%) (Fig. 2). There were lesions in the brainstem in 7 patients (13.7%), and lesions in the cerebellum were found in one case. Compared to a control group, survivors of methanol poisoning had smaller putamina, caudates and pallida (p < 0.01). The most common finding showed damage of the putamen, which is a predilection area of methanol poisoning. An interesting finding was the relatively frequent occurrence of selective lesions of the pallidum, which is found more often in other types of intoxication. Atrophy of basal ganglia was prominent in patients after intoxication.