A 27-year-old man developed acute headache, vomiting and abnormal behaviour for more than 3 days; on the third day, he developed bilateral visual loss, progressing over several hours to complete blindness. There was no fever and no history of seizures or trauma; he initially denied excessive or unusual alcohol consumption. He presented to us 1 month later for the evaluation of blindness. On examination, he had no light perception in either eye. His pupils were dilated and non-reacting, and fundoscopy showed bilateral optic atrophy (figure 1). Routine haematological and biochemical blood tests were normal. An MR scan of the brain showed bilateral haemorrhagic putaminal necrosis (figure 2). On direct questioning when alone, he described drinking local-made alcohol on the day of his illness. Initially, with his …