Severe methanol intoxication with atypical symptoms and imaging changes: a fatal case report

Acute methanol intoxication can occur as accidental ingestion of adulterated spirits. We report a 51-year-old male patient with high anion-gap metabolic acidosis (pH 6.71, HCO(3)(-)4.2 mmol/l, K (+) 6.5mmol/l) because of severe methanol intoxication (450 mg/L, reference level <2.9 mg/L) who presented with atypical symptoms of dizziness and rapidly developed extensive subarachnoid hemorrhage and diffuse cerebral edema and died within several days. Clinicians should have suspicion for subarachnoid hemorrhage in patients with long-term drinking poisoned by methanol with dizziness, consciousness disturbances and severe metabolic acidosis.