title: Bilateral putaminal necrosis and bronopol toxicity.
abstract: Among alcohols, methanol intoxication is the most frequently associated with cerebral toxicity, causing retinal damage and putaminal necrosis. This consequence is believed to be due to the transformation of methanol into formic acid. We describe the case of a patient who presented with acute impairment of consciousness and tetraparesis after she had been drinking several bottles of a topical antiseptic solution (Lysoform Medical) containing 2-bromo-2-nitro-1,3-propandiol (bronopol) among excipients, in order to lose weight during previous months. Moreover, she had been on a strict slimming diet. Soon after admission, a severe respiratory and metabolic impairment became rapidly evident, requiring an intensive care unit admission. Cerebral MRI showed the presence of bilateral putaminal necrosis. She recovered in 10 days, surprisingly, without any evident clinical neurological signs. Methanol, also bronopol, when diluted in aqueous solution, at warm temperature and/or higher pH, may release formaldehyde, which is converted into formic acid, a basal ganglia toxic compound.
authors.affiliation: Clinic of Nervous System Diseases, Ospedali Riuniti Foggia, University of Foggia, Foggia, Italy Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Trivisano
authors.affiliation: Clinic of Nervous System Diseases, Ospedali Riuniti Foggia, University of Foggia, Foggia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Carapelle
authors.affiliation: Clinic of Nervous System Diseases, Ospedali Riuniti Foggia, University of Foggia, Foggia, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Martino
authors.affiliation: Clinic of Nervous System Diseases, Ospedali Riuniti Foggia, University of Foggia, Foggia, Italy.
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Specchio
mesh_terms: D000890:Anti-Infective Agents / Q000506:poisoning*; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009336:Necrosis; D010291:Paresis / Q000209:etiology; D011409:Propylene Glycols / Q000506:poisoning*; D011699:Putamen / Q000187:drug effects* / Q000473:pathology*; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D011409:Propylene Glycols; C006827:bronopol