An illustrated forensic pathology case : bilateral putaminal hemorrhages after methanol ingestion

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.