DELAYED SEQUELAE AFTER ACUTE OVERDOSES OR POISONINGS - CRANIAL NEUROPATHY RELATED TO ETHYLENE-GLYCOL INGESTION

A 31-year-old woman came to the hospital with breathlessness, confusio n, and a refractory anion gap metabolic acidosis; acute renal failure subsequently developed. Her blood ethylene glycol concentration was 39 0 mg/L, and she was treated with an;intravenous ethanol infusion and h emodialysis. During the tenth and eleventh day after admission bilater al seventh cranial nerve paralysis developed, as well as bilateral dys function of cranial nerves II, V, VIII, IX, X, and XII. Magnetic reson ance imaging of her head showed gadolinium enhancement of the fifth cr anial nerve bilaterally and a communicating hydrocephalus. Over the su bsequent 11 months she recovered full function of her cranial nerves V , VII, IX, X, and XII, and she had subjective clinical improvement to baseline function in cranial nerves II and VIII. This case serves to i ntroduce a discussion of agents that cause delayed complications after their acute toxic ingestion.