Hair-Raising Toxicity: Status Epilepticus Following Hair Restoration Due to Local Anesthetic and TXA Toxicity

A 48-year-old man experienced refractory status epilepticus (RSE) during a hair transplant, likely due to the combined neurotoxic effects of local anesthetics and tranexamic acid (TXA). He received 1300 mg oral TXA, 13.6 mL 4% Septocaine, 8 mL 0.5% lidocaine, 18 mL Marcaine, and 500 mg IV TXA, leading to a tonic-clonic seizure unresponsive to initial treatment. The patient required extensive management, including levetiracetam, lipid emulsion therapy, midazolam, propofol, and ketamine infusions. The case highlights the potential for severe neurologic complications from the synergistic effects of local anesthetics and TXA, emphasizing the importance of early recognition and management in procedures involving highly vascular areas.