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Status epilepticus following intravenous N-acetylcysteine therapy
E Hershkovitz1, Z Shorer, A Levitas
1Division of Pediatrics, Soroka Medical Center, Beer Sheva, Israel.
Insights
N-acetylcysteine treatment for acetaminophen overdose can cause temporary cortical blindness in children. This vision loss is likely a postictal effect of seizures, with most vision recovering over time.
Area of Science:
- Pediatric Neurology
- Clinical Toxicology
Background:
- N-acetylcysteine (NAC) is a crucial antidote for acetaminophen (paracetamol) poisoning.
- Status epilepticus and neurological complications are rare but serious adverse events associated with NAC therapy.
Observation:
- A previously healthy 2.5-year-old girl experienced status epilepticus and subsequent cortical blindness during intravenous NAC treatment for paracetamol overdose.
- The patient's visual function showed significant recovery over an 18-month follow-up period.
Findings:
- The cortical blindness is hypothesized to be a postictal sequela following prolonged seizures.
- Respiratory depression induced by N-acetylcysteine is considered a probable contributing factor to the seizure activity and subsequent visual impairment.
Implications:
- This case highlights the importance of monitoring for neurological adverse events during N-acetylcysteine therapy in pediatric patients.
- Clinicians should consider postictal cortical blindness in the differential diagnosis of visual disturbances following status epilepticus, particularly after medication administration.
Abstract:
A previously healthy 2 1/2-year-old girl developed status epilepticus followed by cortical blindness during intravenous N-acetylcysteine therapy for paracetamol ingestion. The child's vision was almost completely recovered during the 18 months follow-up period. We assume that the cortical blindness was a postictal sequela after prolonged seizure episode, most probably due to respiratory depression induced by N-acetylcysteine.