Methanol poisoning and heparin: A dangerous couple?

To the Editor:--Bilateral cerebral ischemia of the basal ganglia is the most well know finding of methanol intoxication that can be identified on computed tomography and magnetic resonance imaging.1,2 Brain hemorrhage is a rare complication that has been related to systemic heparinization during hemodialysis.3,4 We report an unusual case of transformation of bilateral cerebral infarction into massive unilateral hemorrhage after hemodialysis without systemic heparin. Injury to the putamen probably represents a direct toxic effect of methanol metabolites, anoxia, and acidosis, that could be potentiated by a poor venous drainage of this area.5 Other features occasionally described, include edema, necrosis of subcortical white matter, cerebellar cortical lesions, subarachnoid and bilateral intracerebral hemorrhage.1,6 Bilateral brain hemorrhage is a rare complication that has been associated with hemodialysis.