Methanol Intoxication

• Background:
  • Methanol metabolizes into formaldehyde and formic acid, leading to metabolic acidosis and neurologic damage.
• Clinical Presentation:
  • Symptoms are dose-dependent.
  • 12-24 hours following methanol ingestion (latent period)
  • Initial symptoms include visual disturbances, dizziness, and headache.
  • Large amount of ingestion could lead to seizures, stupor, and coma
• Key Diagnostic Features:
  • Bilateral putaminal necrosis and hemorrhage
  • Bilateral white matter edema/necrosis (subcortical white matter T2-hyperintensities)
  • Cerebral and intraventricular hemorrhage
  • Cerebellar necrosis
  • Diffuse cerebral edema
  • Optic nerve demyelination
• Differential Diagnoses:
  • Hypertensive hemorrhage
  • Carbon monoxide intoxication
  • Leigh disease
  • Wilson disease
• Treatment:
  • For acute intoxication (less than 24 hours): ethanol administration to avoid metabolization of methanol by alcohol dehydrogenase enzyme
  • Gastric lavage
  • Correction of metabolic acidosis

Suggested Reading

1. Blanco M, Casado R, Vázquez F, Pumar JM. CT and MR imaging findings in methanol intoxication. AJNR Am J Neuroradiol 2006;27:452–54
2. Halavaara J, Valanne L, Setälä K. Neuroimaging supports the clinical diagnosis of methanol poisoning. Neuroradiology 2002;44:924–28, 10.1007/s00234-002-0855-2
3. Rubinstein D, Escott E, Kelly JP. Methanol intoxication with putaminal and white matter necrosis: MR and CT findings. AJNR Am J Neuroradiol 1995;16:1492–94