Methanol intoxication with cerebral hemorrhage

Methanol is a highly toxic alcohol with a smell and taste similar to ethanol. Small amount around 50 - 100 ml causes permanent blindness and severe neurological dysfunction leads to death.1 More than half of methanol related morbidity and mortality is classified as accidental and therefore preventable. In addition, it can be suicidal by ingestion of a variety of commercial paint thinners, gasoline anti-freeze, windshield products, organic solvents, shellac varnish, washer fluid, photocopying fluids, perfumes, and in some eau de cologne. Occasionally, it is due to the fraudulent adulteration of wine or other alcoholic beverages.2 Its ingestion causes high anion gap metabolic acidosis from the production of formic and lactic acids and central nervous system disturbances ranging from inebriation and drowsiness to obtundation, seizure and coma. Selective toxicity of the optic nerve and basal ganglia are well-known features. Bilateral putaminal necrosis is often recognized radiologically in severe methanol toxicity and usually death occurs within 3 days.2 Here, we report a patient presented with severe high anion gap metabolic acidosis due to methanol intoxication who developed intracerebral bleed during treatment. A 47-year-old man was brought to our hospital by ambulance presented with body pain, nausea, vomiting, and blurring of vision one day ago and sudden loss of vision upon arrival to emergency department. Briefly after admission, became unresponsive, Glasgow Coma Scale 4 with dilated non reactive pupils. His blood pressure was 110/60 mm Hg, heart rate was 95/min, respiratory rate was 32/min (Kussmul’s-Kien breathing), and temperature was 36C.