Methanol poisoning with bilateral basal ganglia necrosis and hemorrhage without visual impairment: A case report

This manuscript describes an unusual case of a 15-year-old male who ingested alcohol fuel, resulting in severe methanol poisoning (blood concentration 175.71 mg/dL). Despite bilateral basal ganglia necrosis and hemorrhage confirmed by CT and MRI, the patient maintained normal vision. Immediate treatment with sodium bicarbonate, hemodialysis, methylprednisolone, folic acid, and vitamin B1 resulted in consciousness recovery within 24 h and normalization of metabolic parameters. Ophthalmologic examination revealed mild right optic disc edema but preserved visual acuity (20/20), normal visual fields, and color vision. At 12-week follow-up, neurological function continued to improve with no visual deterioration. This case demonstrates selective basal ganglia vulnerability in methanol toxicity with sparing of the visual system. Emergency physicians should conduct comprehensive neurological evaluations in methanol poisoning cases regardless of visual symptoms and consider investigating protective mechanisms against methanol-induced optic neuropathy.