A 60-year-old man presented to the emergency department reporting that he accidently swallowed a sip (about 20 mL) of nitromethane he used as fuel for his racing bikes. Over the following 2 days, he became stuporous, experienced tonic-clonic seizures, and ultimately fell into a coma. Brain MRI showed multifocal gray matter T2/fluid-attenuated inversion recovery hyperintensities consistent with previously published findings of acute nitromethane encephalopathy1 (Figure 1, A and B). After 1 week, the follow-up MRI showed massive vasogenic brain edema (Figure 1, C and D). Nonetheless, the patient's condition was improving with supportive therapy only. One month after his admission, he was back to baseline and he was discharged; 6 months later, brain MRI was normal (Figure 2).
Brain MRI 2 days after admission (A, B) shows multifocal signal abnormalities in the gray matter of both cerebral hemispheres (arrowheads in A), quadrigeminal plate, and cerebellum (arrowheads in B). The follow-up brain MRI (C and D), performed during the 10th day of hospitalization, shows partial resolution of the gray matter lesions and development of extensive vasogenic brain edema.
MRI at discharge (A) shows reabsorption of the vasogenic edema, except for a faint residual hyperintensity of the splenium, and resolution of the gray matter lesions; 6 months later, a follow-up MRI (B) is normal.
Study Funding
The authors report no targeted funding.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Acknowledgment
The authors thank Dr. Anna Molinaro (Department of Clinical and Experimental Sciences, University of Brescia, Italy) and Prof. Nicola Latronico (Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Italy) for their contributions.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Teaching slides links.lww.com/WNL/B413
- © 2021 American Academy of Neurology
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