Pseudo-SAH in a patient with methanol poisoning

Methanol poisoning is a dangerous life-threatening event, manifested withvarious symptoms, sometimes very rare ones, that all should be addressed to preventmisdiagnosis of the methanol-poisoned patients.

A 21-year-old young man was brought to the emergency department(ED) with a generalized tonic-clonic (GTC) seizure and he was diagnosed with methanolintoxication. A non-contrast computed tomography (NCCT) of the brain demonstratedfindings similar to subarachnoid hemorrhage (SAH). After the brain CT, he had a GlasgowComa Score (GCS) of 3 and all brainstem reflexes were absent. Neurology consultantagreed with the diagnosis of pseudo-SAH. Brain death was confirmed by a positive apneatest within 24 hours of presentation.

It is suggested that compression of dural sinuses due to severe brain edema,reduces the venous drainage and leads to venous engorgement, which appears highattenuated in the background of low-density edematous brain matter.