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VOLUME 20 , ISSUE 12 ( 2016 ) > List of Articles


Bilateral putaminal necrosis in a comatose patient with metabolic acidosis

Sudhir Kumar, Chenna Reddy, Subhashini Prabhakar

Keywords : Coma, high anion gap, metabolic acidosis, methanol toxicity, putaminal necrosis

Citation Information : Kumar S, Reddy C, Prabhakar S. Bilateral putaminal necrosis in a comatose patient with metabolic acidosis. Indian J Crit Care Med 2016; 20 (12):745-748.

DOI: 10.4103/0972-5229.195720

License: CC BY-ND 3.0

Published Online: 01-11-2017

Copyright Statement:  Copyright © 2016; The Author(s).


We present a case of acute-onset coma in a young woman, associated with metabolic acidosis, respiratory distress, and hypotension. Magnetic resonance imaging of the brain done on day 2 of admission showed features of bilateral putaminal necrosis. History of methanol ingestion, though not forthcoming at admission, was confirmed later after the patient regained consciousness. A final diagnosis of methyl alcohol toxicity resulting in severe metabolic acidosis, coma, and bilateral blindness was made. This case is reported to emphasize the point that the finding of bilateral putaminal necrosis in a patient with coma and metabolic acidosis is virtually diagnostic of methyl alcohol toxicity even in the absence of any positive history.

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