Beware of Neurotoxins in Common Plants: Water Hemlock Poisoning Presenting as Convulsive Status Epilepticus.
Intoxication
Pediatric epilepsy
Seizure
Status epilepticus
Water hemlock
Journal
Pediatric neurology
ISSN: 1873-5150
Titre abrégé: Pediatr Neurol
Pays: United States
ID NLM: 8508183
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
24
09
2021
revised:
23
11
2021
accepted:
26
11
2021
pubmed:
27
12
2021
medline:
19
2
2022
entrez:
26
12
2021
Statut:
ppublish
Résumé
Pediatric status epilepticus occurs in about 44/100.000 children per year with an unknown cause in about a third of patients. One cause can be the ingestion of plants containing toxins that target the central nervous system. Here we describe an ingestion of water hemlock resulting in a status epilepticus. We studied in detail the clinical, laboratory, electrophysiological, and radiological features of a patient with status epilepticus. A 9-year-old boy presented to the pediatric emergency department for sudden onset of nausea, vomiting, and status epilepticus approximately one hour after the patient had bitten into the root of a water plant in an inner-city park. Bilateral tonic-clonic seizures could only be terminated after administration of midazolam, lorazepam, and finally propofol. Cranial MRI, cerebrospinal fluid, and EEG findings were largely unremarkable. The ingested plant was identified as water hemlock through a detailed search with the help of a drawing issued by the patient with the help of the medical team. The specific toxicological analysis for water hemlock verified the presence of cicutoxin and cicudiol in the blood sample. The patient was discharged, levetiracetam was weaned off four weeks later, and he has remained seizure free since. Given the considerable percentage of cases of unknown etiology in new-onset pediatric status epilepticus, it is important to consider plant intoxication as a possible cause.
Sections du résumé
BACKGROUND
Pediatric status epilepticus occurs in about 44/100.000 children per year with an unknown cause in about a third of patients. One cause can be the ingestion of plants containing toxins that target the central nervous system. Here we describe an ingestion of water hemlock resulting in a status epilepticus.
METHODS
We studied in detail the clinical, laboratory, electrophysiological, and radiological features of a patient with status epilepticus.
RESULTS
A 9-year-old boy presented to the pediatric emergency department for sudden onset of nausea, vomiting, and status epilepticus approximately one hour after the patient had bitten into the root of a water plant in an inner-city park. Bilateral tonic-clonic seizures could only be terminated after administration of midazolam, lorazepam, and finally propofol. Cranial MRI, cerebrospinal fluid, and EEG findings were largely unremarkable. The ingested plant was identified as water hemlock through a detailed search with the help of a drawing issued by the patient with the help of the medical team. The specific toxicological analysis for water hemlock verified the presence of cicutoxin and cicudiol in the blood sample. The patient was discharged, levetiracetam was weaned off four weeks later, and he has remained seizure free since.
CONCLUSIONS
Given the considerable percentage of cases of unknown etiology in new-onset pediatric status epilepticus, it is important to consider plant intoxication as a possible cause.
Identifiants
pubmed: 34954473
pii: S0887-8994(21)00256-3
doi: 10.1016/j.pediatrneurol.2021.11.011
pii:
doi:
Substances chimiques
Neurotoxins
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
39-40Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.