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 [email protected]
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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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