Reversible leukoencephalopathy in sodium monofluoroacetate intoxication

Abstract

A 38-year-old man presented with vomiting and progressive mental deterioration after ingesting 210 mL sodium monofluoroacetate solution (SMFA, 2%), a toxic rodenticide, in a suicide attempt. Neither seizure nor tetany was observed. Laboratory tests including EKG, arterial blood gas, serum calcium, and electrolyte were unremarkable. Initial MRI revealed extensive white matter restricted diffusion without disrupted neuronal integrity (figure, A and B). He improved to normal over 2 weeks. Follow-up MRI showed resolution of white matter abnormalities with unaltered metabolic markers (figure, C and D). SMFA selectively inhibits glial Krebs cycle and lowers energy production, with eventual cell death.(1) Reversible MRI cytotoxic edema without neuronal loss(2) suggests that SMFA intoxication is in the differential diagnosis of reversible leukoencephalopathy.