Advanced Imaging in Methanol Toxicity: Bilateral Putaminal Necrosis and Frontal-Occipital Ischemia-A Case Report

Methanol toxicity remains a critical yet challenging diagnosis due to its nonspecific early presentation and potential for delayed intervention. Although methanol itself is nontoxic, its metabolite-formic acid-induces severe metabolic acidosis and neurotoxicity, particularly affecting the basal ganglia and optic nerves. We present a case of a male in his 50s with altered mental status and visual impairment following windshield washer fluid ingestion. Initial computed tomography (CT) was unremarkable, but follow-up imaging revealed bilateral putaminal necrosis and subcortical white matter involvement, including the frontal and occipital lobes. Diffusion-weighted imaging (DWI) findings demonstrated acute ischemia and necrosis, underscoring the value of advanced imaging when methanol toxicity is suspected. This case highlights the importance of recognizing characteristic radiological patterns to facilitate timely diagnosis and improve patient outcomes.