Canadian Journal of Medicine

We report the case of a 24-year-old man admitted to the emergency room with a history of headache exacerbated. At the emergency room, he was unresponsive to drug or alcohol consumption. At this time, computed tomography (CT) did not detect the brain and abdomen lesions. At the intensive care unit (ICU), 6h later, he suddenly developed shallow respirations, followed by loss of consciousness, hypotension, and blurred vision. He was intubated immediately and underwent mechanical ventilation. Arterial blood gases and biochemical analyses indicated intense metabolic acidosis (Day1: pH 7.25, PCO2 49 mmHg, PO2 65 mmHg, HCO3 15 mmol/L and day 2, pH 7.32, PCO2 45 mmHg, PO2 60 mmHg, and HCO3=19 mmol/L) and elevated liver enzymes. The clinical diagnosis of toxic alcohol ingestion was based on the history, arterial blood gases results, and significant biochemical changes. In ICU, the patient underwent ethanol infusion and hemodialysis and the impression of methanol intoxication. He underwent redialysis with a minimal dose of heparin (5000 IU/mL). A second CT scan revealed basal ganglia ischemia, and an MRI scan exhibited clear abrasion and basal ganglia necrosis. Finally, he died  due to severe methanol intoxication, but the probability of cerebral hemorrhage may be the cause of the patient death associated with heparin.

This review describes the more important developments of the neuroimaging of multiple
sclerosis (MS) in recent years, and provides a discussion of advanced MR imaging
techniques with regard to current findings, clinical correlations, and future directions. MS
pathology is originally defined by the presence of focal white matter lesions,
characterized by inflammatory/demyelinating, axonal loss, edema, blood brain barrier
break-down, and neurodegenerative processes that occur earlier in life, which usually
affects the gray and white matter, brainstem, cerebellum, spinal cord and optic nerve. In
recent years, the use of MRI techniques represents as a powerful tool to non-invasively
study different pathological substrates of lesions and microscopic tissue changes.
Techniques such as T2-weighted and gadolinium-enhanced T1-weighted MRI are very
sensitive in detecting lesions and, thus, increase the level of certainty of MS diagnosis.
In this review, we summarize the main evidence supporting the use of advanced MRI
techniques provide a better understanding of the neuropathologic processes that most
likely are related to disease activity and clinical progression in MS. Such metrics are able
to reveal a range of tissue changes that include inflammation, demyelination, axonal loss,
reactive glial scaring, neurodegeneration and neuroinflammation. In conclusion, MRI has
had a major impact on diagnosing MS, understanding the condition, and monitoring the
effects of clinical treatments