Propofol-Associated Seizure-Like Phenomenon During Anesthetic Induction: A Case Report

Abstract Propofol is a widely used intravenous anesthetic agent known for its anticonvulsant properties and off-label use in refractory status epilepticus. However, paradoxical excitatory manifestations, collectively termed seizure-like phenomena (SLP), have been documented despite their central nervous system-depressant profile. These reactions are rare and often under-recognized. We report a case of a 28-year-old male with a remote history of spinal cord compression but no prior seizures, who developed seizure-like activity immediately after propofol administration during induction of general anesthesia for cystolithotomy. The episode was characterized by upward rolling of eyeballs, stiffening of extremities, generalized tonic–clonic seizures, and decorticate posturing, which resolved spontaneously. A second episode occurred during patient positioning, prompting the postponement of surgery. Laboratory tests, blood gases, and imaging revealed no metabolic or intracranial pathology. The patient was referred to the neurology service, which suggested a propofol-induced etiology in the absence of other causes. One week later, the procedure was completed under general anesthesia without propofol, and no recurrence of seizure-like activity was observed. Proposed mechanisms include modulation of GABAergic and glycinergic neurotransmission and suppression of cortical excitatory signals. The absence of seizure recurrence when propofol was avoided supports a likely causal relationship. This case underscores that although propofol is predominantly anticonvulsant, it may paradoxically induce SLP even in neurologically intact patients.