Cefepime-induced generalized tonic–clonic seizures in traumatic brain injury

Neurotoxicity is a well-documented adverse effect of cefepime, though its occurrence in patients with traumatic brain injury has not been readily described in recent literature. Cefepime crosses the blood–brain barrier, and neurotoxic manifestations are most frequently reported in critically ill patients, particularly those with renal impairment. A 76-year-old male presented to the emergency department after a fall, leading to episodes of staring and confusion. Neuroimaging revealed a subdural hematoma (SDH). Concurrent urinalysis was abnormal, raising concern for infection, and sepsis protocol was initiated due to the Systemic Inflammatory Response Syndrome criteria. During the initial days of hospitalization, the patient’s neurologic status deteriorated and eventually progressed to generalized tonic–clonic seizures and encephalopathy. The SDH remained stable on serial imaging and did not warrant surgical intervention. Review of his antimicrobial regimen suggested cefepime-induced neurotoxicity, and the antibiotic was subsequently replaced with ceftriaxone. Within 2 days of discontinuation, seizures ceased, and mental status gradually improved. At discharge, the patient was neurologically stable with residual mild dysarthria.