What is the Cause of Seizure: Isoniazid Poisoning or Epidural Hematoma? A Case Report

Abstract

Introduction: Isoniazid (INH) is the primary drug that is widely used in the treatment of tuberculosis. Because of the decrease in the incidence of tuberculosis, the usage of INH and its associated intoxications have decreased with time. In this case, we present a patient who was admitted to the emergency department (ED) with seizure attack, wherein it could not be determined whether the cause of the seizure was INH poisoning or epidural hematoma.Case Report: A 26-year-old woman was brought to the emergency department because of self-poisoning with an over-dosage of INH. On arrival at the ED, she had a seizure. Arterial blood gas analysis revealed lactic acidosis and hyperglycemia. At the same time, she had a head trauma, and brain computed tomography demonstrated epidural hematoma; thus, 18 mg/kg phenytoin was initiated for seizure prophylaxis. Intravenous pyridoxine treatment was planned for intoxication of INH; however, the treatment was not available because of the absence of this drug in our local region. Conclusion: As in our case, if the patient is concurrently diagnosed with epidural hematoma in addition to INH poisoning, it can be difficult to discriminate the cause of seizure. Although lactic acidosis, hyperglycemia, and seizure were defined as a classical triad for INH poisoning, this triad can be observed in many types of seizures