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Neurotoxic overdose in a young man: question
Journal of Clinical Neuroscience 23 (2016) 129
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
Neurotoxic overdose in a young man: question Aleksi Suo a,⇑, James Scozzafava b,c a
Department of Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada c Department of Adult Critical Care Medicine, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada b
1. Clinical background A 33-year-old man was taken to the emergency department after his family observed a 5 day history of worsening depressive symptoms and new onset confusion. He had a history of a previous suicide attempt, but he had no other medical conditions and was not on any medications. The initial investigations found metabolic acidosis with an anion gap of 32. His serum osmolality was 558 mmol/kg, with an osmolar gap of 268 mmol/kg. The liver enzymes were mildly elevated with an aspartate aminotransferase level of 242 units/L and an alanine aminotransferase level of 247 units/L. His level of consciousness quickly deteriorated and he was intubated and transferred to the intensive care unit. The head CT scan was normal. Toxic alcohol ingestion was suspected and he was immediately treated with fomepizole, thiamine, folate and pyridoxine. He also received hemodialysis treatment. A brain MRI was obtained (Fig. 1).
2. The most likely diagnosis is: A. B. C. D. E.
Ethylene glycol intoxication Diethylene glycol intoxication Isopropanol intoxication Methanol intoxication Propylene glycol intoxication
Answer on page 170
DOI of answer: http://dx.doi.org/10.1016/j.jocn.2015.06.011
⇑ Corresponding author. Tel.: +1 306 880 2594; fax: +1 306 844 1525. E-mail address: [email protected] (A. Suo). http://dx.doi.org/10.1016/j.jocn.2015.05.030 0967-5868/Ó 2015 Elsevier Ltd. All rights reserved.
Fig. 1. (A) T2-weighted axial, (B) T2-weighted axial gradient recalled echo (GRE) and (C) T1-weighted sagittal brain MRI.
Conflicts of Interest/Disclosures The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
Neurotoxic overdose in a young man: question Aleksi Suo a,⇑, James Scozzafava b,c a
Department of Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada c Department of Adult Critical Care Medicine, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada b
1. Clinical background A 33-year-old man was taken to the emergency department after his family observed a 5 day history of worsening depressive symptoms and new onset confusion. He had a history of a previous suicide attempt, but he had no other medical conditions and was not on any medications. The initial investigations found metabolic acidosis with an anion gap of 32. His serum osmolality was 558 mmol/kg, with an osmolar gap of 268 mmol/kg. The liver enzymes were mildly elevated with an aspartate aminotransferase level of 242 units/L and an alanine aminotransferase level of 247 units/L. His level of consciousness quickly deteriorated and he was intubated and transferred to the intensive care unit. The head CT scan was normal. Toxic alcohol ingestion was suspected and he was immediately treated with fomepizole, thiamine, folate and pyridoxine. He also received hemodialysis treatment. A brain MRI was obtained (Fig. 1).
2. The most likely diagnosis is: A. B. C. D. E.
Ethylene glycol intoxication Diethylene glycol intoxication Isopropanol intoxication Methanol intoxication Propylene glycol intoxication
Answer on page 170
DOI of answer: http://dx.doi.org/10.1016/j.jocn.2015.06.011
⇑ Corresponding author. Tel.: +1 306 880 2594; fax: +1 306 844 1525. E-mail address: [email protected] (A. Suo). http://dx.doi.org/10.1016/j.jocn.2015.05.030 0967-5868/Ó 2015 Elsevier Ltd. All rights reserved.
Fig. 1. (A) T2-weighted axial, (B) T2-weighted axial gradient recalled echo (GRE) and (C) T1-weighted sagittal brain MRI.
Conflicts of Interest/Disclosures The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.