Acute cerebral white matter damage in lethal salicylate intoxication.
A 34-year-old oligophrenic woman was admitted in comatose state with marked tachypnea. History revealed the oral ingestion of a large amount of acetylsalicylate to attenuate ear pain within the preceding 3 days. Laboratory investigations showed a toxic concentration of serum salicylate (668 mg/l, toxic range above 200 mg/l) and metabolic acidosis. Oxygenation, blood pressure, electrocardiography, echocardiography and CT of thorax and brain were normal. The patient was intubated, fluid and bicarbonate was given intravenously. Six hours after admission asystolia refractory to resuscitation led to death. Autopsy showed venous congestion of the brain, cardiac dilatation and pulmonary edema. Brain histopathology showed myelin disintegration and caspase-3 activation in glial cells, whereas, grey matter changes were sparse. Acute white matter damage is suggested to be the substrate of cerebral dysfunction in salicylate intoxication and possible mechanisms are discussed.
Rauschka
Helmut
H
Department of Neurology, Hospital Hietzing, and Department of Neuroimmunology, Brain Research Institute, Medical University Vienna, Austria. helmut.rauschka@univie.ac.at
Aboul-Enein
Fahmy
F
Bauer
Jan
J
Nobis
Hans
H
Lassmann
Hans
H
Schmidbauer
Manfred
M
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000506:poisoning*; D001241:Aspirin / Q000506:poisoning*; D001344:Autopsy; D015415:Biomarkers; D001921:Brain / Q000473:pathology*; D001923:Brain Chemistry / Q000187:drug effects; D053148:Caspase 3 / Q000378:metabolism; D016923:Cell Death / Q000187:drug effects; D002550:Cerebral Veins / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009186:Myelin Sheath / Q000473:pathology; D009457:Neuroglia / Q000473:pathology; D009474:Neurons / Q000473:pathology; D011654:Pulmonary Edema / Q000139:chemically induced / Q000473:pathology; D016707:Tissue Fixation
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D053148:Caspase 3; D001241:Aspirin