Ischemic and Hemorrhagic Brain Damage in Methanol Poisoning: A Case of Rapid Deterioration

BACKGROUND Methanol is a toxic alcohol that is often ingested accidentally or intentionally. Its metabolites can induce severe visual disturbances, metabolic acidosis, and neurological dysfunction, which can frequently become life-threatening. CASE REPORT A 44-year-old woman with a history of depression and alcohol use was hospitalized in the Intensive Care Unit after cardiopulmonary reanimation. According to relatives, an empty bottle of household chemicals was found next to the patient. The patient had symptoms of vomiting, headache, and vision loss. The patient had a hypertensive crisis, with blood pressure of 180/110 mmHg. Initially, on the computed tomography of the head, no conclusive acute changes were detected. However, a slight hypodensity in the basal nuclei was marked retrospectively. On day 4, magnetic resonance imaging of the head was performed, showing symmetrical acute ischemic changes in the basal nuclei with hemorrhage and spreading into the ventricles, and acute occlusive hydrocephalus. Bilateral acute symmetric ischemic changes of both optic nerves with cytotoxic edema were also detected on diffusion-weighted imaging. Dynamically, the condition did not improve, and all vital functions worsened. The patient's lethal outcome was confirmed. CONCLUSIONS Cerebral hemorrhage is a rare and serious complication of methanol poisoning. Early sign detection of methanol intoxication is crucial due to the rapid progression of severe, irreversible complications. Neuroimaging has a significant role in diagnosing and understanding the extent of damage in methanol poisoning cases.