Methanol toxicity presenting as haemorrhagic putaminal necrosis and optic atrophy Prabhat Singh, 1 Vimal Kumar Paliwal, 1 Zafar Neyaz, 2 Vikas Kanaujia 3 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ practneurol-2012-000500). 1 Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India 3 Department of Neuro Ophthalmology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Correspondence to Dr Vimal Kumar Paliwal, Department of Neurology, SGPGIMS, Raebareli Road, Lucknow 226014, India; dr_vimalkpaliwal@rediffmail.com Published Online First 13 March 2013 To cite: Singh P, Paliwal VK, Neyaz Z, et al. Pract Neurol 2013;13:204–205. A 27-year-old man developed acute head- ache, vomiting and abnormal behaviour for more than 3days; on the third day, he developed bilateral visual loss, pro- gressing over several hours to complete blindness. There was no fever and no history of seizures or trauma; he initially denied excessive or unusual alcohol con- sumption. He presented to us 1 month later for the evaluation of blindness. On examination, he had no light perception in either eye. His pupils were dilated and non-reacting, and fundoscopy showed bilateral optic atrophy (figure 1). Routine haematological and biochemical blood tests were normal. An MR scan of the brain showed bilateral haemorrhagic putaminal necrosis (figure 2). On direct questioning when alone, he described drinking local-made alcohol on the day of his illness. Initially, with his parents there, he had denied drinking alcohol, and they were unaware of his drinking habit. We diagnosed methanol toxicity based on the acutely painful vision loss with optic atrophy, the characteristic imaging and the onset after consuming local-made alcohol. He did not know of other people who were similarly affected from the same source of alcohol. Over the 4 months following diagnosis, his vision has gradually improved to percep- tion of hand movements at 30 cm. Methanol is extremely toxic to human beings. Fermentation of fruits and grains yields a mixture of ethanol, propanol, methanol and water; the methanol, being the most volatile, is extracted as the initial distillate. Industrial alcoholic bev- erages are produced by proper distillation methods and contain only harmless traces of methanol. However, home-made or local-made alcohol may sometimes contain large amounts of methanol, from either adulteration, excess formation or improper distillation. 1 Since methanol’s appearance and odour are similar to ethanol, drinkers of these cheap, illegally made alcohols risk sustaining methanol toxicity. Such outbreaks are not uncom- mon, especially in developing countries. 2 Isolated patients with methanol toxicity are difficult to diagnose if the history of alcohol intake is concealed for social or legal reasons. Bilateral haemorrhagic putaminal necrosis is rare. Its causes include Figure 1 Fundus photograph showing optic atrophy. Note that the visible optic nerve layer reflection is due to photo flash artefact. Figure 2 MR scan of the brain showing (A) bilateral putaminal hyperintensity on T2-weighted image with (B) blooming on the gradient echo image, due to haemorrhage. NEUROIMAGING 204 Singh P, et al. Pract Neurol 2013;13:204–205. doi:10.1136/practneurol-2012-000500