Abstract
A 50-year-old man was admitted to our hospital with complaints of blindness and consciousness disturbance. Neurosurgeons suspected “top of the basilar” syndrome because of atrial fibrillation and bilateral basal ganglia lesions detected by head magnetic resonance imaging (MRI); however, angiography of the vertebral arteries confirmed the absence of the syndrome. He became comatose and had severe metabolic acidosis; therefore methanol intoxication was strongly suspected. He was admitted to the intensive care unit and intubated; he received hemodialysis and was administered ethanol and activated folate. He recovered consciousness but remained blind and disoriented. His head MRI revealed bilateral putaminal and subcortical hemorrhagic necrosis. He was transferred to a mental hospital because he was in a delusional state. Delay in treatment can lead to serious sequelae in methanol intoxication, and it takes several days to measure the methanol level in the blood. It is necessary to diagnose methanol intoxication on the basis of clinical findings, serum osmolal gap, and the pathognomonic changes detected by head computed tomography (CT) or MRI.
