title: Two cases of rapid onset Parkinson's syndrome following toxic ingestion of ethylene glycol and methanol.
abstract: Ethylene glycol and methanol are toxic alcohols commonly found in a variety of commercial products. We report two cases, one associated with ethylene glycol and one with methanol poisoning, which both led to acute hemorrhagic necrosis of the basal ganglia and resulted in acute Parkinson's syndrome. It is unlikely that oxalate crystal deposition is the only mechanism for such basal ganglia necrosis, because similar findings were seen following methanol intoxication. We discuss other possible mechanisms that may contribute towards this unusual neurotoxicity. Both of our patients survived their toxic ingestions, but then developed acute Parkinson's syndrome within 10 days of the ingestion. However, the patient who ingested methanol developed respiratory muscle stiffness/weakness, which responded poorly to anti-Parkinsonian drug therapy. Treatment with carbidopa/levodopa improved cogwheel rigidity and bradykinesia in both patients. We conclude that acute Parkinsonism is one of the lesser-recognized devastating complications of both ethylene glycol and methanol poisoning.
authors.affiliation: Section of Clinical Pharmacology and Toxicology, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Reddy
authors.forename: L D
authors.initials: LD
authors.lastname: Lewis
authors.forename: T B
authors.initials: TB
authors.lastname: Gardner
authors.forename: W
authors.initials: W
authors.lastname: Osterling
authors.forename: C J
authors.initials: CJ
authors.lastname: Eskey
authors.forename: D W
authors.initials: DW
authors.lastname: Nierenberg
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000187:drug effects / Q000473:pathology; D002230:Carbidopa / Q000627:therapeutic use; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D000432:Methanol / Q000506:poisoning*; D009336:Necrosis; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D012131:Respiratory Insufficiency / Q000139:chemically induced; D014057:Tomography, X-Ray Computed
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa; D019855:Ethylene Glycol; D002230:Carbidopa; D000432:Methanol