Abstract Details

Title Acute visual disturbance associated with hydrogen peroxide ingestion

Topic General Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-041

Objective To describe a case of visual field deficit with associated leptomeningeal enhancement in a patient with hydrogen peroxide ingestion.

Background Hydrogen peroxide has recently been promoted as a therapy for health and wellness. Neurologic complications of hydrogen peroxide ingestion are not often reported but include ischemic strokes from air emboli.

Design/Methods Case report from a tertiary care center.

Results A 40-year-old woman without significant past medical history presented with abdominal pain, hematemesis, right sided headache, and decreased visual acuity following accidental ingestion of 35% hydrogen peroxide. Her initial work up revealed pneumatosis of the stomach and mediastinum, and possible air in the portal venous system. Patient’s visual acuity worsened to complete visual loss over a few hours. She underwent hyperbaric oxygen therapy. Subsequently, vision improved gradually, with residual left homonymous hemianopia. MRI brain with gadolinium demonstrated right hemispheric leptomeningeal enhancement and no acute infarct. Her visual field deficit continued to improve and after 24 hours, a left upper quadrantanopia remained. Further follow up was not available as patient returned to her home in another state.

Conclusions Hydrogen peroxide has been shown to dysregulate endothelial function and to alter blood-brain-barrier permeability by a variety of mechanisms including oxidative stress, tight junction disruption, and alteration in cytoskeletal organization. Ingestion of concentrated hydrogen peroxide likely altered the cerebral vasculature resulting in this patient’s visual field deficit.

Authors/Disclosures
Jiae Lee, MD (Montefiore) PRESENTER	No disclosure on file
Olivia Tong, MD	Dr. Tong has received personal compensation for serving as an employee of Alexion Pharmaceuticals.

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