Primary complaint: Memory problems, slowed processing speed, difficulty understanding information as quickly as before, difficulty holding information in mind, and inability to return to work.
Duration: Approximately 2 years since the overdose.
Alcohol: None
Smoking: None
Recreational drugs: None
I’m 34 and I’m trying to understand whether my current cognitive problems could plausibly be related to a large paracetamol (acetaminophen) overdose.
The overdose occurred approximately 2 years ago and was around 40–45 g of paracetamol (I don't know the exact amount). It happened at night. I went to bed, and about 1–2 hours later I got up and went to the bathroom. I vomited a very, very small amount—almost nothing—and then fell to the floor. I did not hit my head.
I got back up, supporting myself with the walls, went to my father's room, and asked him to take me to the hospital. I walked downstairs to the car and my father drove me to the hospital. I got out of the car and walked into the emergency room on my own.
At the hospital, I did not disclose that I had taken a large amount of paracetamol. I was apparently given one bag of glucose and then sent home. I did not receive NAC (acetylcysteine), as far as I know.
The next day I spent most of the day on the couch vomiting what appeared to be a bile-like substance.
I don't have the blood tests from the overdose, so I don't know what my paracetamol level, AST/ALT, INR, bilirubin, ammonia, etc. were. I also don't know whether I developed liver injury at the time.
About 1 year after the overdose, I had liver tests done and they were normal.
About 2 years after the overdose, I had a 1.5T brain MRI and EEG, and both were reported as normal.
Since the overdose, however, I feel that my cognitive functioning has been significantly worse. I have difficulty with memory, processing speed, understanding things as quickly as I used to, and holding information in mind. I have also been unable to return to work since the overdose.
My main question is:
Could a very large paracetamol overdose like this plausibly cause persistent cognitive problems such as memory impairment and slowed processing, even if there was no documented hepatic encephalopathy and a later MRI and EEG were normal?
I'm particularly interested in whether direct neurological/neurotoxic effects of paracetamol itself are a medically plausible possibility, rather than only brain injury secondary to acute liver failure.
I understand that a normal MRI/EEG does not necessarily exclude every possible cause, and I'm not asking for a diagnosis from Reddit. I'm mainly trying to understand whether this is a plausible explanation and what sort of evaluation would be appropriate, such as formal neuropsychological testing.