Methanol-related deaths: evaluation of findings in a 111-case autopsy series

Methanol poisoning is a significant public health problem associated with high mortality and severe neurological damage. This study aimed to evaluate the relationship between central nervous system (CNS) findings, blood methanol levels, and hospitalization duration in fatal methanol poisoning cases.

A total of 111 cases with confirmed death due to methanol poisoning, autopsied between January 1, 2021 and June 30, 2025, were retrospectively analyzed. Scene investigation, clinical, toxicological, and histopathological findings were evaluated. CNS findings were analyzed in relation to methanol concentrations and duration of hospitalization. Statistical analyses were performed using IBM SPSS Statistics version 27.

The majority of cases occurred during the COVID-19 period (66.7%), with a marked male predominance (92.8%). Exposure most frequently occurred in domestic settings (58.6%). The mean blood methanol level was 230.2 mg/dl (range: 12-827), and levels > 100 mg/dl were detected in 59.5% of cases. Higher blood methanol levels were significantly associated with shorter hospitalization duration (p < 0.001). A substantial proportion of high-dose cases resulted in death within the first 48 h. CNS findings, including necrosis, hemorrhage, and severe parenchymal softening, were significantly more frequent in cases with longer durations of hospitalization (p < 0.001).

Neuropathological findings were more frequently observed in cases with longer hospitalization durations. In high-dose methanol intoxication, rapid death may prevent the development of detectable structural CNS lesions; therefore, the absence of CNS pathology does not exclude fatal methanol intoxication. Furthermore, postmortem methanol levels may be reduced by medical treatment, emphasizing the need for a comprehensive forensic evaluation integrating toxicological, clinical, and treatment data.