Neuroimaging features in diethylene glycol poisoning

Alterações de neuroimagem cerebral na intoxicação por dietilenoglicol

A 55-year-old man presented with acute onset vomiting, tetraplegia and ptosis, that progressed to renal failure and coma, four days after consuming beer. Several people that consumed that specific beer developed similar symptoms. Brain MRI showed restricted diffusion on cerebellum and thalamus (Figures 1 and 2). Beer analysis showed high levels of diethylene glycol. Patient died days later.

Diethylene glycol is a substance commonly used in industrial products including antifreeze and coolant. Its toxicity causes severe metabolic acidosis, coma and multiorgan failure1. Neurological toxicity is less well characterized, but brain MRI lesions may include cerebellar and thalamic abnormalities, with diffuse restriction2.

Figure 1.
Axial FLAIR- (A) and T2-weighted (B) brain MRI shows bilateral hyperintense signal in the superior region of the cerebellar hemispheres (arrows). Axial FLAIR- (C) and T2-weighted (D) brain MRI shows hyperintense signal in ventromedial region of the thalamus (arrows).

Figure 2.
Axial DWI / ADC-weighted brain MRI discloses restricted diffusion at the superior region of the cerebellar hemispheres (A) and in the ventromedial region of the thalamus (B), with respective correspondence on ADC images (C and D).

References

• 1. Schep LJ, Slaughter RJ, Temple WA, Beasley DM. Diethylene Glycol Poisoning. Clin Toxicol (Phila). 2009 Jul;47(6):525-35. https://doi.org/10.1080/15563650903086444
  » https://doi.org/10.1080/15563650903086444
• 2. Imam YZB, Kamran S, Karim H, Elalamy O, Sokrab T, Osman Y, Deleu D. Neurological manifestation of recreational fatal and near-fatal diethylene glycol poisonings: case series and review of literature. Medicine (Baltimore). 2014 Aug;93(10):e62. https://doi.org/10.1097/md.0000000000000062
  » https://doi.org/10.1097/md.0000000000000062

• Ethical statement:

  Family members of the patient consented with the publication of the manuscript.

Publication Dates

• Publication in this collection
  11 June 2021
• Date of issue
  July 2021

History

• Received
  20 July 2020
• Accepted
  26 Sept 2020