After nitromethane fuel ingestion, an 18-year-old male mechanic presented with generalized tonicclonic seizures progressing to partial motor status epilepticus. At physical examination hypertension was noted. Symptomatic therapy was initiated, including valproic acid, -blockers, and clonidine. When neurologic examination could be performed, it showed mild left dysmetria in finger-to-nose testing, low-frequency intention tremor, broad-based gait, and inability to tandem-walk. MRI (figure) demonstrated bilateral and symmetric lesions in cerebellar white matter, tonsils, uvula, and colliculi. Valproic acid was maintained. Clinical and MRI 8-month follow-up showed no abnormalities. To our knowledge, this is the first documented case of reversible encephalopathy by nitromethane ingestion.
1,2Elena Alventosa Fernández, MD, Candelaria González González, MD, Javier Crisóstomo Pardillo, MD, Vicente Martín García, MD, Santa Cruz de Tenerife, Spain Disclosure: The authors report no conflicts of interest. Address correspondence and reprint requests to Dr. Elena Alventosa Fernández, C/Santa Rosalía, 5-3°, 38002 Santa Cruz de Tenerife, Spain; elena.alventosa@gmail.com814814 These lesions were less conspicuous on T2-weighted images. Symmetric lesions support the diagnosis of toxic encephalopathy.
