This meta-analysis aimed to evaluate the pooled prevalence of key cranial magnetic resonance imaging (MRI) findings in methanol poisoning, including putaminal necrosis, optic nerve injury, and mortality.
Objective
Methanol intoxication is a potentially fatal condition causing severe neurological deficits, yet the prevalence of MRI-detected brain lesions remains incompletely characterized.
Methods
A systematic review and meta-analysis were conducted following PRISMA 2020 and Cochrane Handbook guidelines. Studies reporting MRI findings in patients with confirmed methanol poisoning were retrieved from Medline, Scopus, and Web of Science. A random-effects model was used to pool proportions, and heterogeneity was assessed using the I2 statistic.
Results
Thirteen studies were included in the systematic review. Of these, eight studies contributed data on putaminal necrosis (n = 163), four on optic nerve injury (n = 108), and seven on in-hospital mortality (n = 154). Patients were predominantly male, aged 17–77 years, with oral ingestion as the main exposure route. Mortality showed a pooled prevalence of 7.8% (95% CI 2.2–24.1; I2 = 53.9%). Optic nerve injury had a pooled prevalence of 36.1% (95% CI 9.2–75.8; I2 = 84.0%). Putaminal necrosis was the most frequent MRI finding, with a pooled prevalence of 47.6% (95% CI 30.3–65.6; I2 = 75.0%).
Conclusion
MRI abnormalities are highly prevalent in methanol poisoning. Putaminal necrosis is the hallmark radiologic feature, while optic nerve injury affects approximately one-third of cases. These findings support MRI as a key tool for assessing methanol-induced neurotoxicity.
BertauMOffermannsHPlassL, et al.The basic chemical and energy feedstock of the future. Springer eBooks, 2014.
2.
OlahGA. Beyond oil and gas: the methanol economy. ChemInform [Internet]2005; 36(29): chin.200529289.
3.
KlaassenCD. Casarett & Doull’s toxicology: the basic science of poisons. 9th ed.Mcgraw-Hill Education, 2018.
4.
McMartinKEMartin-AmatGNokerPE, et al.Lack of a role for formaldehyde in methanol poisoning in the monkey. Biochem Pharmacol [Internet]1979; 28(5): 645–649.
OnanHBPiskinFCDemirT, et al.Neuroradiological features and clinical outcomes in methanol intoxication. Ces Slov Neurol Neurochir2021; 84: 1.
9.
SharpeJAHostovskyMBilbaoJM, et al.Methanol optic neuropathy: a histopathological study. Neurology [Internet]1982; 32(10): 1093–1100.
10.
BezdicekOMichalecJVaneckovaM, et al.Cognitive sequelae of methanol poisoning involve executive dysfunction and memory impairment in cross-sectional and long-term perspective. Alcohol [Internet]2017; 59: 27–35.
11.
PaasmaRHovdaKEJacobsenD. Methanol poisoning and long term sequelae - a six years follow-up after a large methanol outbreak. BMC Clin Pharmacol [Internet]2009; 9(1): 5.
SadeghiMFakharMHoseininejadSM, et al.The clinico-epidemiological, diagnostic and therapeutic aspects of methanol poisoning: a five-year retrospective study, northern Iran. Drug Alcohol Depend [Internet]2023; 253(111024): 111024.
15.
HalavaaraJValanneLSetäläK. Neuroimaging supports the clinical diagnosis of methanol poisoning. Neuroradiology [Internet]2002; 44(11): 924–928.
16.
RubinsteinDEscottEKellyJP. Methanol intoxication with putaminal and white matter necrosis: MR and CT findings. AJNR Am J Neuroradiol1995; 16(7): 1492–1494.
17.
HsuHHChenCYChenFH, et al.Optic atrophy and cerebral infarcts caused by methanol intoxication: MRI. Neuroradiology1997; 39(3): 192–194.
18.
SefidbakhtSRasekhiARKamaliK, et al.Methanol poisoning: acute MR and CT findings in nine patients. Neuroradiology2007; 49(5): 427–435.
19.
ManaJVaneckovaMKlempířJ, et al.Methanol poisoning as an acute toxicological basal ganglia lesion model: evidence from brain volumetry and cognition. Alcohol Clin Exp Res2019; 43(7): 1486–1497.
20.
KotikovaKZogalaDPtacnikV, et al.Efficiency of 123I-ioflupane SPECT as the marker of basal ganglia damage in acute methanol poisoning: 6-year prospective study. Clin Toxicol (Phila)2021; 59(3): 235–245.
21.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ2021; 372: n71.
22.
ElkhamarySMFahmyDMGalvez-RuizA, et al.Spectrum of MRI findings in 58 patients with methanol intoxication: Long-term visual and neurological correlation. Egypt J Radiol Nucl Med2016; 47(3): 1049–1055.
23.
HantsonPDuprezTMahieuP. Neurotoxicity to the basal ganglia shown by magnetic resonance imaging (MRI) following poisoning by methanol and other substances. J Toxicol Clin Toxicol1997; 35(2): 151–161.
24.
HlusickaJManaJVaneckovaM, et al.MRI-based brain volumetry and retinal optical coherence tomography as the biomarkers of outcome in acute methanol poisoning. Neurotoxicology2020; 80: 12–19.
25.
KotikovaKKlepisPRidzonP, et al.Peripheral polyneuropathy after acute methanol poisoning: Six-year prospective cohort study. Neurotoxicology2020; 79: 67–74.
OnanHBPiskinFCDemirT, et al.Neuroradiological features and clinical outcomes in methanol intoxication. Čes slov neurol neurochir2021; 84/117(5): 1.
28.
ÖnderFİlkerSKansuT, et al.Acute blindness and putaminal necrosis in methanol intoxication. Int Ophthalmol1998; 22(2): 81–84.
29.
PeterováKBrožováHKlempířJ, et al.Gait and balance impairment after acute methanol poisoning. Basic Clin Pharmacol Toxicol2018; 122(1): 176–182.
30.
RulisekJWaldaufPBelohlavekJ, et al.Health-related quality of life determinants in survivors of a mass methanol poisoning outbreak: six-year prospective cohort study. Clin Toxicol2020; 58(9): 870–880.
31.
KurtasOImreKYOzerE, et al.The evaluation of deaths due to methyl alcohol intoxication. Biomed Res Int2017; 2017: 3680–3687.
32.
ZakharovSPelclovaDDiblikP, et al.Long-term visual damage after acute methanol poisonings: longitudinal cross-sectional study in 50 patients. Clin Toxicol (Phila)2015; 53(9): 884–892.
33.
ZakharovSHlusickaJNurievaO, et al.Neuroinflammation markers and methyl alcohol induced toxic brain damage. Toxicol Lett2018; 298: 60–69.
34.
HanstonPDuprezTMahieuP. Neurotoxicity to the basal ganglia shown by magnetic resonance imaging (MRI). J Toxicol Clin Toxicol1997; 35(2): 151–161.
35.
GonzalezquevedoAObregónFUrbinaM, et al.Effect of chronic methanol administration on amino acids and monoamines in retina, optic nerve, and brain of the rat. Toxicol Appl Pharmacol2002; 185(2): 77–84.
36.
BeltzEEMullinsME. Radiological reasoning: hyperintensity of the basal ganglia and cortex on FLAIR and diffusion-weighted imaging. AJR Am J Roentgenol2010; 195(3 Suppl): S1–S8.
AhiskaliIPinarCLKikiM, et al.Effect of taxifolin on methanol-induced oxidative and inflammatory optic nerve damage in rats. Cutan Ocul Toxicol2019; 38(4): 384–389.
39.
SaoudiMJebahiSJamoussiK, et al.Haematological and biochemical toxicity induced by methanol in rats: ameliorative effects of Opuntia vulgaris fruit extract. Hum Exp Toxicol2011; 30(12): 1963–1971.
40.
ChimelliLGrayF. Acquired metabolic disorders. Escourolle and Poirier’s Manual of Basic Neuropathology. 5th ed.Oxford University Press, 2013, pp. 205–226.
41.
SharmaVKTanJH. Post-hypoxic early selective putaminal necrosis followed by delayed extensive subcortical demyelination. Brain Inj2007; 21(11): 1199–1202.
42.
SarbuNShihRYJonesRV, et al.White matter diseases with radiologic-pathologic correlation. Radiographics2016; 36(5): 1426–1447.
43.
AlzahraniY. Pediatric posterior reversible encephalopathy syndrome: a review with emphasis on neuroimaging characteristics. Cureus2023; 15(12): e51216.
44.
SchwartzRB. Hyperperfusion encephalopathies: hypertensive encephalopathy and related conditions. Neurol2002; 8(1): 22–34.
45.
SunQSunMZhangY, et al.Clinical characteristics of methanol-induced optic neuropathy: correlation between aetiology and clinical findings. J Ophthalmol2022; 2022: 4671671.
46.
Galvez-RuizAElkhamarySMAsgharN, et al.Visual and neurologic sequelae of methanol poisoning in Saudi Arabia. Saudi Med J2015; 36(5): 568–574.
47.
NurievaOHubacekJAUrbanP, et al.Clinical and genetic determinants of chronic visual pathway changes after methanol-induced optic neuropathy: four-year follow-up study. Clin Toxicol2019; 57(6): 387–397.
48.
ReddyNJSudiniMLewisLD. Delayed neurological sequelae from ethylene glycol, diethylene glycol and methanol poisonings. Clin Toxicol2010; 48(10): 967–973.
49.
LiuDChenJXiaW, et al.Effects of methanol and formic acid on CRYB, ALDH2, and ATP5A1 of retinal ganglion cells. Cutan Ocul Toxicol2022; 41(3): 221–225.
50.
SharpeJAHostovskyMBilbaoJM, et al.Methanol optic neuropathy. Neurology1982; 32(10): 1093–1100.
51.
ÖnderFİlkerSKansuT, et al.Acute blindness and putaminal necrosis in methanol intoxication. Int Ophthalmol1998; 22(2): 81–84.
52.
WangTZhangYGuY, et al.Neurological sequelae in acute carbon monoxide poisoning: a prospective observational study with MRI data. Acta Neurol Scand2022; 145(5): 590–598.
53.
ZaknunJJStieglbauerKTrenklerJ, et al.Cyanide-induced akinetic rigid syndrome: clinical, MRI, FDG-PET, β-CIT and HMPAO SPECT findings. Parkinsonism Relat Disord2005; 11(2): 125–129.
54.
WhiteMLZhangYHelveyJT, et al.Anatomical patterns and correlated MRI findings of non-perinatal hypoxic–ischaemic encephalopathy. Br J Radiol2013; 86(1021): 20120464.
55.
MisserSKArcharyM. Mimickers of hypoxic-ischaemic brain injury in term neonates: what the radiologist should know. S Afr J Radiol2024; 28(1): 2810.
56.
FujiokaMOkuchiKHiramatsuK, et al.Specific changes in human brain after hypoglycemic injury. Stroke1997; 28(3): 584–587.
57.
SharmaPEesaMScottJN. Toxic and acquired metabolic encephalopathies: MRI appearance. AJR Am J Roentgenol2009; 193(3): 879–886.
58.
KetataILoghmariDSouaS, et al.Acute methanol poisoning in Tunisia: clinical features, biological and associated factors for mortality. Tunis Med2022; 100(10): 706–712.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
