ACMT Toxicology Visual Pearls: Abnormal Brain Imaging

An 85 year-old man presented with coma after ingestion of a household product. Two key axial views of his brain MRI are shown. Which of the following did he ingest? Apple cider vinegar Bleach Drain cleaner Ethylene glycol Hydrogen peroxide Peer reviewed on behalf of ACMT by Dr. Bryan Judge, Dr. Louise Kao, and Dr. Daniel Ruysniak References 1. Hendriksen S, Menth N, Westgard B, et al. Hyperbaric oxygen therapy for the prevention of arterial gas embolism in food grade hydrogen peroxide ingestion. Am J Emerg Med. 2017;35(5):809.e5-809.e8. [PubMed] 2. Byrne B, Sherwin R, Courage C, et al. Hyperbaric oxygen therapy for systemic gas embolism after hydrogen peroxide ingestion. J Emerg Med. 2014;46(2):171-175. [PubMed] 3. Rider S, Jackson S, Rusyniak D. Cerebral air gas embolism from concentrated hydrogen peroxide¬† ingestion. Clin Toxicol (Phila). 2008;46(9):815-818. [PubMed] 4. Vander H, Seamon J. Resolution of delayed altered mental status associated with hydrogen peroxide ingestion following hyperbaric oxygen therapy. Acad Emerg Med. 2003;10(9):998-1000. [PubMed] 5. Dickson K, Caravati E. Hydrogen peroxide exposure–325 exposures reported to a regional poison control center. J Toxicol Clin Toxicol. 1994;32(6):705-714. [PubMed] 6. Hatten B, French L, Horowitz B, Hendrickson R. Outcomes After High-Concentration Peroxide Ingestions. Ann Emerg Med. 2017;69(6):726-736.e2. [PubMed] Bio Latest Posts Laura Tormoehlen, MD, FACMT, FAANAssociate Professor of Clinical Neurology and Clinical Emergency Medicine Indiana University School of Medicine Latest posts by Laura Tormoehlen, MD, FACMT, FAAN (see all) ACMT Toxicology Visual Pearls: Abnormal Brain Imaging – January 21, 2019 Bio Latest Posts Jeff C. Miller, MDAdjunct Professor of Neurology University of North Carolina School of Medicine Atrium Health at Carolinas Medical Center Latest posts by Jeff C. Miller, MD (see all) ACMT Toxicology Visual Pearls: Abnormal Brain Imaging – January 21, … Continue reading ACMT Toxicology Visual Pearls: Abnormal Brain Imaging