Cerebral seizures, cardiopulmonary resuscitation, and posterior reversible encephalopathy syndrome after accidental ingestion of xylocain gel 2%

Case Report: We report the case of a 2-year-old boy developing posterior reversible encephalopathy syndrome (PRES) 2 days after unobserved ingestion of approximately 500 mg viscous lidocaine (40 mg/kg of bodyweight). Initially the intoxication presented with convulsive status epilepticus and subsequent cardiac arrest necessitating cardiopulmonary resuscitation for 8 minutes. After 2 days of full recovery the child presented with progressive disorientation, dizziness, and visual neglect. Lasting for 2 days these symptoms finally disappeared completely. Combined with the findings on cerebral magnetic resonance imaging this episode was interpreted as PRES. Two weeks after the ingestion no neurological and visual abnormalities were found.

Ingestion of viscous lidocaine in children can lead to potentially lethal neurological and cardiac effects. Posterior reversible encephalopathy syndrome is a neurotoxic condition related to chemotherapeutics, hypertension, and autoimmune disorders presenting with altered mental status, seizures, and visual disturbances. To our knowledge the association of lidocaine intoxication and PRES has not been described yet.