Neurology Publish Ahead of PrintDOI: 10.1212/WNL.0000000000012178

Teaching NeuroImages: Nitromethane-Induced Acute Reversible Encephalopathy

Author(s): Giovanni Palumbo, MD1; Michele Besana, MD2; Sofia Ananiadou, MD3; Carolina Giordano, MD4; Gloria

Maccabelli, MD2; Mario Riccio, MD3; Chiara Campana, MD5; Alessia Giossi, MD5; Enrico Piovan, MD6;

Davide Lonati, MD7; Lorenzo Pinelli, MD8

Corresponding Author: Giovanni Palumbo gio17.palumbo@gmail.com

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Published Ahead of Print on May 12, 2021 as 10.1212/WNL.0000000000012178

Affiliation Information for All Authors: 1. Radiology Department, Università degli Studi di Brescia, Brescia, Italy; 2. Diagnostic and interventional Neuroradiology, ASST Cremona, Cremona, Italy; 3. Intensive Care Unit, ASST Cremona, Cremona, Italy; 4. Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care Department, ASST Papa Giovanni XXIII, Bergamo, Italy; 5. Neurology Unit, ASST Cremona, Cremona, Italy; 6. Neuroradiology Unit, ASST Mantova, Mantova, Italy; 7. Poison Control Centre and National Toxicology Information Centre - Toxicology Unit, Istituti Clinici Scientifici Maugeri , IRCCS Maugeri Hospital and University of Pavia , Pavia, Italy; 8. Neuroradiology Unit, ASST Spedali Civili, Brescia, Italy

Contributions: Giovanni Palumbo: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data

Michele Besana: Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data Sofia Ananiadou: Major role in the acquisition of data

Carolina Giordano: Major role in the acquisition of data

Gloria Maccabelli: Major role in the acquisition of data

Mario Riccio: Major role in the acquisition of data

Chiara Campana: Major role in the acquisition of data

Alessia Giossi: Major role in the acquisition of data

Enrico Piovan: Major role in the acquisition of data

Davide Lonati: Major role in the acquisition of data; Analysis or interpretation of data

Lorenzo Pinelli: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data

Number of characters in title: 52

Abstract Word count: 104

Word count of main text: 104

References: 1

Figures: 2

Tables: 0

Neuroimage Legend Count: 113

Search Terms: [ 18 ] Coma, [ 76 ] Generalized seizures, [ 120 ] MRI, [ 261 ] Solvents

Acknowledgements: We thank Dr. Anna Molinaro (Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy) and Prof. Nicola Latronico (Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy) for their expert contribution and thoughtful remarks.

Study Funding: The authors report no targeted funding

Disclosures: All authors report no disclosures.

Copyright © 2021 American Academy of Neurology. Unauthorized reproduction of this article is prohibited

A 60-year-old man presented to the emergency department reporting he accidentally swallowed a sip (about 20 mL) of nitromethane he used as fuel for his racing bikes. Over the following two days, he became stuporous, experienced tonic-clonic seizures, and ultimately fell into a coma. Brain MRI showed multifocal gray matter T2/FLAIR hyperintensities consistent with previously published findings of acute nitromethane encephalopathy1 (Figure 1 A and B). After one week the follow-up MRI showed massive vasogenic brain edema (Figure 1 C and D). Nonetheless, the patient’s condition was already improving with supportive therapy only. One month after his admission he was back to baseline and he was discharged; six months later brain MRI was normal (Figure 2).

Appendix 1: Authors

Name Location Contribution

Giovanni Palumbo MD

Radiology Department, Università degli Studi di Brescia, Brescia, Italy

Drafting/revision of the manuscript for content, including medical writing for content; Study

concept or design; Analysis or interpretation of data

Michele Besana MD

Diagnostic and interventional Neuroradiology, ASST Cremona, Cremona, Italy

Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data

Sofia Ananiadou MD

Intensive Care Unit, ASST Cremona, Cremona, Italy Major role in the acquisition of data

Carolina Giordano MD

Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy

Major role in the acquisition of data

Gloria Maccabelli MD

Diagnostic and interventional Neuroradiology, ASST Cremona, Cremona, Italy

Major role in the acquisition of data

Mario Riccio MD

Intensive Care Unit, ASST Cremona, Cremona, Italy Major role in the acquisition of data

Chiara Campana MD

Neurology Unit, ASST Cremona, Cremona, Italy Major role in the acquisition of data

Alessia Giossi MD

Neurology Unit, ASST Cremona, Cremona, Italy Major role in the acquisition of data

Copyright © 2021 American Academy of Neurology. Unauthorized reproduction of this article is prohibited

Enrico Piovan MD

Neuroradiology Unit, ASST Mantova, Mantova, Italy Major role in the acquisition of data

Davide Lonati MD

Poison Control Centre and National Toxicology Information Centre - Toxicology Unit, Istituti Clinici Scientifici Maugeri , IRCCS Maugeri Hospital and University of Pavia , Pavia, Italy

Major role in the acquisition of data; Analysis or interpretation of data

Lorenzo Pinelli MD

Neuroradiology Unit, ASST Spedali Civili, Brescia, Italy

Drafting/revision of the manuscript for content, including medical writing for content; Major role in

the acquisition of data; Study concept or design; Analysis or interpretation of data

[AZ 3.17.2021] 132746 Teaching Slides -- http://links.lww.com/WNL/B413

References

1. Elena Alventosa Fernández, Candelaria González González, Javier Crisóstomo Pardillo, Vicente Martín García Nitromethane encephalopathy MRI. Neurology Mar 2008, 70 (10) 814; DOI: 10.1212/01.wnl.0000304254.18355.b3

Copyright © 2021 American Academy of Neurology. Unauthorized reproduction of this article is prohibited

Captions

Figure 1: Brain MRI, axial (A, C) and coronal (B, D) FLAIR image. Brain MRI two days after the admission (A, B), showed 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, D), performed during the 10th day of hospitalization, showed partial resolution of the gray matter lesions and development of extensive vasogenic brain edema.

Copyright © 2021 American Academy of Neurology. Unauthorized reproduction of this article is prohibited

Figure 2: Brain MRI, axial FLAIR images (A, B). MRI at discharge (A) showed reabsorption of the vasogenic edema, except for a faint residual hyperintensity of the splenium, and resolution of the gray matter lesions; six months later, a follow-up MRI (B) was normal.

Copyright © 2021 American Academy of Neurology. Unauthorized reproduction of this article is prohibited

DOI 10.1212/WNL.0000000000012178 published online May 12, 2021Neurology 

Giovanni Palumbo, Michele Besana, Sofia Ananiadou, et al. Teaching NeuroImages: Nitromethane-Induced Acute Reversible Encephalopathy

This information is current as of May 12, 2021

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