title: Bilateral putaminal hemorrhages: serious complication of methanol intoxication.
abstract: BACKGROUND
  Methanol intoxication is a life-threatening condition. Hallmark of clinical presentations include severe wide anion gap metabolic acidosis with very high serum osmolar gap and visual complication.
  
  
  METHODS
  We report a case of severe methanol intoxication with bilateral putaminal hemorrhage, an uncommon serious complication. A 56-year-old man presented with altered mental status. Fundus examination showed optic disc edema. Arterial Blood Gas (ABG) revealed severe anion gap metabolic acidosis with osmolal gap. Head computed tomography (CT) showed hypodense lesions in basal ganglia bilaterally. Hemodialysis and intravenous fomepizole were initiated. Serum methanol level was significantly elevated. Unfortunately, patient was lethargic 2 weeks after discharge. Repeated CT of head demonstrated new putaminal hemorrhages.
  
  
  CONCLUSIONS
  Bilateral putaminal hemorrhage is an uncommon but serious complication in methanol intoxication. Clinicians should have high index of suspicion for putaminal hemorrhage when patients with recent methanol intoxication present with altered mental status.
authors.affiliation: Department of Medicine, Bassett Medical Center, Cooperstown, New York, USA.
authors.forename: Nitipong
authors.initials: N
authors.lastname: Permpalung
authors.affiliation: Department of Medicine, Bassett Medical Center, Cooperstown, New York, USA.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Department of Medicine, Bassett Medical Center, Cooperstown, New York, USA.
authors.forename: Daych
authors.initials: D
authors.lastname: Chongnarungsin
authors.affiliation: Department of Medicine, Bassett Medical Center, Cooperstown, New York, USA.
authors.forename: Travis M
authors.initials: TM
authors.lastname: Hodgdon
keywords: Basal ganglion hemorrhage; Metabolic acidosis; Methanol intoxication; Putaminal hemorrhage