Methyl iodide poisoning presenting as a mimic of acute stroke: a case report

Abstract

IntroductionStroke mimics are usually non-vascular disease processes. These raise the possibility of a stroke and are common in clinical practice. It is necessary to distinguish these mimics in order to provide early and appropriate management, as well as reduce possible harm on our patient.Case presentationWe report the case of a 50-year-old Caucasian man who developed symptoms suggestive of posterior circulation stroke after he was exposed to methyl iodide at his workplace. Results of stroke investigations of our patient were negative, and a detailed occupational history clinched the diagnosis. Acute presentation with a stroke-like picture is rare in cases of methyl iodide poisoning. We have attempted to discuss the differential diagnosis of stroke mimics through a review of literature.ConclusionStroke mimics are difficult to diagnose in an emergency room situation and may be initially treated as stroke. This case report underlines the importance of history taking, especially occupational history, in the differential diagnosis of stroke. We also stress the need to recognize mimics at presentation in order to arrive at an early and appropriate management of patients.

Methyl Iodide Exposure Presenting as Severe Chemical Burn Injury with Neurological Complications and Prolonged Respiratory Insufficiency

“…3 Until now, only 13 documented cases of methyl iodide exposure-induced injury have been reported. [6][7][8][9] These cases, in particular, describe different neurological malfunctions such as vertigo, ataxia, diplopia, agitation, confusion, delirium, episodes of giddiness and sleepiness, nystagmus, strabismus, coma, cerebellar signs, or paresis. 6 In one case, methyl iodide exposure led to death.…”

Clozapine Intoxication Mimicking Acute Stroke

“… 9 Medications are a rare etiology of stroke mimic, which has only been described previously in case reports of methyl iodine and prochlorperazine. 10 , 11 Presentations that mimic posterior circulation strokes are particularly challenging as the symptoms of posterior circulation stroke, such as ataxia, dizziness, and dysarthria, are shared with many alternative etiologies. 12 Given the need for rapid decision-making in acute ischemic stroke, misdiagnosis and inappropriate treatment with thrombolytic therapy have become increasing common.…”

Methyl iodide rhombencephalopathy: clinico-radiological features of a preventable, potentially fatal industrial accident

“…The differential diagnosis includes acute demyelination, meningoencephalitis or poisoning by other toxic agents, particularly other monohalomethanes. Methyl iodide poisoning can mimic a posterior circulation stroke 4. Clearly, the occupational and clinical history are the key to the diagnosis.…”