Abstract:
We report the case of a 45-year old African male, who presented to the Emergency
Department with severe metabolic lactic acidosis and confusion secondary to ingestion
of methylated spirits. Methylated spirits is a common household product. He was
declared brain dead the following day.
A medico-legal autopsy was performed immediately thereafter in accordance with the
national regulations. Autopsy examination demonstrated bilateral putaminal
haemorrhages.
Bilateral putaminal haemorrhages, in combination with metabolic lactic acidosis and
visual impairment, is pathognomonic for methanol ingestion.
Why specifically the putamen is affected by methanol poisoning while other structures
of the basal ganglia stay intact, is addressed in this paper.
The selectivity of putaminal damage is thought to be due to a higher sensitivity to the
acidic metabolite formic acid; another theory suggests phylogenetical differences to the
other basal ganglia.
