Advertisement

Neurocritical Care

, Volume 3, Issue 2, pp 171–173 | Cite as

Severe ethylene glycol intoxication mimicking acute basilar artery occlusion

  • Hagen B. HuttnerEmail author
  • Christian Berger
  • Stefan Schwab
Perspectives In Intoxications

Abstract

We report a patient with severe ethylene glycol poisoning initially mimicking acute basilar artery occlusion and elucidate the importance of immediate diagnosis and treatment: a previously healthy 59-year-old truck driver presenting with hallmarks of basilar artery syndrome after having consumed an unknown substance. Immediate application of intravenous ethanol and hemodialysis could not prevent the development of a malignant brain edema within hours. This report describes a new clinical presentation of severe ethylene glycol intoxication mimicking acute basilar artery occlusion with the development of a fatal brain edema within hours, despite adequate treatment.

Key Words

Ethylene glycol poisoning basilar artery occlusion fomepizole acidosis brain edema 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Egbert PA, Abraham K. Ethylene glycol intoxication: pathophysiology, diagnosis, and emergency management. ANNA J 1999;26:295–300, 335; quiz 301–2.PubMedGoogle Scholar
  2. 2.
    Butler J. Antifreeze poisoning. Emerg Nurse 1999;7:14–18.PubMedGoogle Scholar
  3. 3.
    Lobert S. Ethanol, isopropanol, methanol, and ethylene glycol poisoning. Crit Care Nurse 2000;20:41–47.PubMedGoogle Scholar
  4. 4.
    Megarbane B, Borron SW, Baud FJ. Current recommendations for treatment of severe toxic alcohol poisonings. Intensive Care Med 2005;31:189–195.PubMedCrossRefGoogle Scholar
  5. 5.
    Brandt T. Diagnosis and thrombolytic therapy of acute basilar artery occlusion: a review. Clin Exp Hypertens 2002;24:611–622.PubMedCrossRefGoogle Scholar
  6. 6.
    Abramson S, Singh AK. Treatment of the alcohol intoxications: ethylene glycol, methanol and isopropanol. Curr Opin Nephrol Hypertens 2000;9:695–701.PubMedCrossRefGoogle Scholar
  7. 7.
    Morgan BW, Ford MD, Follmer R. Ethylene glycol ingestion resulting in brainstem and midbrain dysfunction. J Toxicol Clin Toxicol 2000;38:445–451.PubMedCrossRefGoogle Scholar
  8. 8.
    Rasic S, Cengic M, Golemac S, Macanovic M. Acute renal insufficiency after poisoning with ethylene glycol. Nephron 1999;81:119–120.PubMedCrossRefGoogle Scholar
  9. 9.
    Lewis LD, Smith BW, Mamourian AC. Delayed sequelae after acute overdoses or poisonings: cranial neuropathy related to ethylene glycol ingestion. Clin Pharmacol Ther 1997;61:692–699.PubMedCrossRefGoogle Scholar
  10. 10.
    Smith RA, Lang DG. Rapid determination of ethylene glycol and glycolic acid in biological fluids. Vet Hum Toxicol 2000;42:358–360.PubMedGoogle Scholar
  11. 11.
    Imbenotte M, Azaroual N, Cartigny B, Vermeersch G, Lhermitte M. Detection and quantitation of xenobiotics in biological fluids by 1H NMR spectroscopy. J Toxicol Clin Toxicol 2003;41:955–962.PubMedCrossRefGoogle Scholar
  12. 12.
    Glaser DS. Utility of the serum osmol gap in the diagnosis of methanol or ethylene glycol ingestion. Ann Emerg Med 1996;27:343–346.PubMedCrossRefGoogle Scholar
  13. 13.
    Fujita M, Tsuruta R, Wakatsuki J, et al. Methanol intoxication: differential diagnosis from anion gap-increased acidosis. Intern Med 2004;43:750–754.PubMedCrossRefGoogle Scholar
  14. 14.
    Hylander B, Kjellstrand CM. Prognostic factors and treatment of severe ethylene glycol intoxication. Intensive Care Med 1996;22:546–552.PubMedGoogle Scholar
  15. 15.
    Yao HH, Porter WH. Simultaneous determination of ethylene glycol and its major toxic metabolite, glycolic acid, in serum by gas chromatography. Clin Chem 1996;42:292–297.PubMedGoogle Scholar
  16. 16.
    Vetrano SJ, Schier JG. Ethanol and the osmolal gap. Ann Emerg Med 2002;40:655–656; author reply 657–658.PubMedCrossRefGoogle Scholar
  17. 17.
    Haviv YS, Rubinger D, Zamir E, Safadi R. Pseudo-normal osmolal and anion gaps following simultaneous ethanol and methanol ingestion. Am J Nephrol 1998;18:436–438.PubMedCrossRefGoogle Scholar
  18. 18.
    Scalley RD, Ferguson DR, Piccaro JC, Smart ML, Archie TE. Treatment of ethylene glycol poisoning. Am Fam Physician 2002;66:807–812.PubMedGoogle Scholar
  19. 19.
    Brent J, McMartin K, Phillips S, et al. Fomepizole for the treatment of ethylene glycol poisoning. Methylpyrazole for Toxic Alcohols Study Group. N Engl J Med 1999;340:832–838.PubMedCrossRefGoogle Scholar
  20. 20.
    Sivilotti ML, Burns MJ, McMartin KE, Brent J. Toxicokinetics of ethylene glycol during fomepizole therapy: implications for management. For the Methylpyrazole for Toxic Alcohols Study Group. Ann Emerg Med 2000;36:114–125.PubMedCrossRefGoogle Scholar
  21. 21.
    Watson WA. Ethylene glycol toxicity: closing in on rational, evidence-based treatment. Ann Emerg Med 2000;36:139–141.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc 2005

Authors and Affiliations

  • Hagen B. Huttner
    • 1
    Email author
  • Christian Berger
    • 1
  • Stefan Schwab
    • 1
  1. 1.Department of Neurology-ICUUniversity of HeidelbergHeidelbergGermany

Personalised recommendations