19 December 2024
: Case report 
Ischemic and Hemorrhagic Brain Damage in Methanol Poisoning: A Case of Rapid Deterioration
Challenging differential diagnosis, Management of emergency care, Rare disease
Arturs Balodis
ABCDEFG 1,2*, Ramona Valante CDEF 3, Laura Saule BCDEF 1,2, Ginta Balode BCDEF 4, Marta Pūpola BCDEF 5
DOI: 10.12659/AJCR.945731
Am J Case Rep 2024; 25:e945731
Table 1. A timeline with chronology events of patient status.
| Day | Time | Status | Treatment |
|---|---|---|---|
| Day 1 | Before hospitalization | On the day of admission, the patient began to report vision loss and pain in the stomach, which was accompanied with profuse vomiting. When paramedics arrived, the patient’s blood pressure was 180/110 mmHg. Patient was transported to hospital. On the way to hospital, the patient suddenly had an asystole, and cardiopulmonary reanimation was performed; after 5 min, sinus rhythm was achieved | Naloxone 1 mg i.v., Sol. vit B1 (thiamine) 400 mg i.v., Sol. Ringer’s lactate 500.0 mL ×4 i.v., Sol. tramadol 20 mL i.v., Perf. KCl 7.45% 50 mL i.v. ×3, Tab. monoprile 10 mg, Tab. omeprazole 20 mg |
| 12: 20 | and angiography of the head, brachiocephalic and intracranial arteries and chest and abdominal cavity CT | ||
| 14: 40 | Examination of the patient in the Emergency Department. Severe general condition. Unconsciousness. Decision on hospitalization made in the Intensive Care Unit | ||
| 14: 50 | The patient with an unclear diagnosis was transferred to the Intensive Care Unit. Pupils were wide, Glasgow Coma Scale (GCS) score=3, blood pressure 167/93 mmHg, heartrate 112 beats per min. | ||
| Day 2 | 7: 30 | During the night, the patient’s condition did not change significantly. The patient reacted to pain irritation with a slight flexion in the right hand. Pupils of eyes medium wide, reaction to light preserved, GCS score=3, BP on the background of labetalol 141/69 mmHg, temperature 37.8°C | Sol. vit B1 (thiamine) 400 mg i.v., Sol. Ringer’s lactate 500.0 mL ×4 i.v., Sol. labetolol 20 mL i.v., Perf. KCl 7.45% 50 mL i.v. ×3, Perf. noradrenaline solution 4 mg/50 mL i.v., Sol. mannitol 15% 100/150 mL ×4, Perf. propofol 500 mg i.v., Torasemide 20 mg i.v., Tab. monoprile 10 mg ×2, Tab. omeprazole 20 mg ×2 |
| 11: 00 | The patient cannot be contacted, visual acuity cannot be determined. Diagnosis=papilledema | ||
| 12: 20 | Magnetic resonance imaging (MRI) of the head | ||
| 14: 00 | The general condition of the patient is extremely severe, GCS score=3, BP 123/65 mmHg, heartrate 77 beats per min. Breathing is provided through mechanical lung ventilation with parameters: SIMV mode O2 30% PEEP 5 Pc/Ps 15 | ||
| Day 3 | 7: 00 | The patient’s condition remained serious for the past day. GCS score=3, BP 122/62 mmHg, heartrate 79 beats per min. Breathing was provided through mechanical lung ventilation with parameters: SIMV mode Fi02 = 0.3 Ppeak 12 x’ Pic=15 | Sol. vit B1(thiamine) 400 mg i.v., Sol. Ringer’s lactate 500.0 mL ×4 i.v., Sol. labetolol 20 mL i.v., Perf. KCl 7.45% 50 mL i.v., Perf. propofol 500 mg i.v., Perf. noradrenaline solution 4 mg/50 mL i.v., Tab. monoprile 10 mg ×2, Tab. moxonidine 0.4 mg, Tab. omeprazole 20 mg, Erythrocyte mass 240 mL ×2 |
| 13: 50 | The patient’s condition was extremely serious, without any changes | ||
| Day 4 | 7: 00 | During the night, the patient’s condition did not change significantly. Sedation removed. Pupils of the eye wide, did not react to light, GCS=3. Breathing was provided through mechanical lung ventilation in SIMV mode with 30% 02. BP on the background of noradrenaline solution (4 mg/50 mL) was 105/64 mmHg | Sol. mannitol 15% 1000 ml i.v., Sol. NaCl 0,9% 1000 mL i.v., noradrenaline 4 mg i.v., Perf. KCl 7,45% 50 mL i.v., Tab. monoprile 10 mg, Tab. moxonidine 0.4 mg, Susp. omeprazol 20 mg |
| 12: 00 | The patient’s condition was extremely serious, without any changes | ||
| 20: 20 | The patient developed bradycardia, and hemodynamic instability increased. An irreversible profound neurological deficit persisted. Spontaneous breaths were not detected. As bradycardia progressed, asystole occurred, leading to exitus letalis |