Refractory Status Epilepticus Following Erroneous Intrathecal Injection of Tranexamic Acid: A Case Report and Long-Term Follow-Up and Narrative Review.

INTRODUCTION

Accidental intrathecal injection of tranexamic acid (TXA) is a rare but catastrophic preventable adverse event associated with high mortality and severe neurological consequences. It represents a major neurological emergency that requires immediate specialized management.

CASE PRESENTATION: A 32-year-old man erroneously received an intrathecal injection of 300 mg of TXA instead of bupivacaine during a saphenous vein stripping procedure. He rapidly developed refractory myoclonic status epilepticus, sympathetic hyperactivity, and rhabdomyolysis. Management included multiple antiseizure medications, continuous EEG-guided sedation, and targeted use of neuromuscular blockade. The patient recovered without immediate neurological deficit but developed persistent cognitive impairment and posttraumatic stress disorder at follow-up.

CONCLUSIONS

This case highlights the severe neurotoxicity of intrathecal TXA and the importance of early and aggressive intensive care management. It also underscores the need for long-term multidisciplinary follow-up for the assessment of anesthetic procedure-related complications.