Status epilepticus following intravenous N-acetylcysteine therapy

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E Hershkovitz1, Z Shorer, A Levitas

  • 1Division of Pediatrics, Soroka Medical Center, Beer Sheva, Israel.

Israel Journal of Medical Sciences
|November 1, 1996
PubMed

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.

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