Acute methanol intoxication may result in a wide range of damage to the central nervous system. Most patients are typically admitted to the hospital for several days after methanol ingestion, presenting with visual disruptions, severe acidosis, or both. Rapid diagnosis and treatment are necessary to prevent death and to minimize the neurological sequelae. We want to emphasize the importance of specific MRI findings in a patient, who had drunk a bottle of beer and 70 mL of spirits, and was admitted to hospital after 20 hours, with severe metabolic acidosis and loss of consciousness. A methanol assay was unavailable. © 2013 by Erciyes University School of Medicine.