Brain Images Reveal Methanol Poisoning Associated with COVID-19 Pandemic

Reports last month of individuals in Iran drinking methanol in a misguided attempt to ward off or cure COVID-19 infection have translated into cases of methanol poisoning seen with CT scans showing brain damage.

And, with the widespread use of a variety of alcohol-based sanitizers and disinfectants sustained and continuing to rise, recognizing the impacts of excessive exposure can be critical, researchers said.

In a letter published April 6 in Academic Radiology, radiologists from Iran discussed this emerging trend, based on false information, among COVID-19 patients. The belief spread, initially killing 300 and making more than another 1,000 people ill. Many of the intoxicated patients presented to emergency departments having consumed improperly made or boot-legged alcohol, according to the researchers from Shiraz University of Medical Sciences and Shahid Beheshti University of Medical Sciences.

“There are severe restrictions on the production and consumption of alcoholic beverages in Iran, as in many other Islamic countries,” the team wrote, “and, many are the victims of illicitly produced liquor containing methanol.”

These patients experienced varying degrees of decreased consciousness, headache, vertigo, and impaired vision.

Based on axial non-enhanced brain CT scans, individuals with methanol poisoning experience bilateral symmetrical decreased density of lentiform nuclei, especially putamina, and massive hemorrhage in the left lentiform nucleus.

A second case, including an axial T2 weighted MR image of the brain showed a symmetrical increased signal intensity of basal ganglia.

According to the team, methanol poisoning characteristics have been widely discussed in existing literature. Bilateral necrosis of basal ganglia is one of the most common radiologic features. Putaminal involvement is also considered characteristic, likely due to either decreased blood flow through the basal vein or Rosenthal as a result of hypotension or accumulation of high concentrations of formic acid, a metabolite of methanol.

Although methanol poisoning is largely caused by methanol consumption, it can also occur through inhalation or skin absorption. And, as more sanitizers and disinfecting alcohol products are sprayed into the air, including homemade varieties that might include substitute ingredients, radiologists should be aware of these characteristics and remain vigilant for any potential cases.

“Familiarity of the clinicians, especially those working in emergency departments, with clinical and radiological presentations of methanol poisoning is essential,” the team wrote, “as delayed diagnosis and treatment result in high mortality.”