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Case Studies01:22

Case Studies

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There are many research methods available to psychologists in their efforts to understand, describe, and explain behavior and the cognitive and biological processes that underlie it.
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Case 345.

Ajay Malhotra1, Mihran Khdhir1

  • 1Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520.

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Summary
This summary is machine-generated.

This case highlights a severe metabolic acidosis in a patient with altered mental status after heavy alcohol consumption. Brain MRI revealed characteristic findings, underscoring the importance of advanced imaging in diagnosing alcohol-related brain injury.

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Area of Science:

  • Neurology
  • Toxicology
  • Emergency Medicine

Background:

  • A 64-year-old male presented with unresponsiveness and confusion after excessive alcohol intake.
  • Initial assessment revealed hypoxia and severe metabolic acidosis with a high anion gap.

Purpose of the Study:

  • To describe the neuroimaging findings in a patient with severe metabolic acidosis and altered mental status following alcohol intoxication.
  • To correlate clinical presentation with neuroimaging results in a case of potential alcohol-related brain injury.

Main Methods:

  • A comprehensive metabolic panel, arterial blood gas analysis, and lactate levels were obtained.
  • Noncontrast head CT and CT angiography were performed initially.
  • Brain MRI, including diffusion-weighted imaging (DWI), T2-FLAIR, and susceptibility-weighted imaging (SWI), was conducted 8 hours post-presentation.

Main Results:

  • Arterial blood gas analysis showed a pH of 6.86, bicarbonate of 5.4 mmol/L, and an elevated anion gap of 28 mmol/L.
  • Lactate was significantly elevated at 7.8 mmol/L.
  • Initial CT scans were normal, but subsequent brain MRI demonstrated findings consistent with alcohol-related brain injury (detailed in Figs 1-5).

Conclusions:

  • Severe metabolic acidosis and altered mental status in the context of heavy alcohol intake warrant thorough investigation.
  • Brain MRI, particularly DWI, is crucial for identifying subtle or characteristic changes associated with alcohol-related neurological complications.
  • This case underscores the utility of advanced neuroimaging in diagnosing and understanding the extent of brain injury in toxicological emergencies.