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Metronidazole-Induced Encephalopathy: Case Report and Review of MRI Findings

Published online by Cambridge University Press:  02 December 2014

Jamsheed A. Desai ,
Jessica Dobson ,
Michel Melanson ,
Giovanna Pari  and
Albert Yongwon Jin
Jamsheed A. Desai
Affiliation:
Department of Medicine (Neurology), Queen's University
Jessica Dobson
Affiliation:
Queen's Medical School, Kingston, Ontario, Canada
Michel Melanson
Affiliation:
Department of Medicine (Neurology), Queen's University
Giovanna Pari
Affiliation:
Department of Medicine (Neurology), Queen's University
Albert Yongwon Jin*
Affiliation:
Department of Medicine (Neurology), Queen's University
*
Queen's University, Department of Medicine, Division of Neurology, Kingston General Hospital, Connell 7-76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada
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A 74-year-old man presented with a four week history of behavioural disturbances, upper and lower extremity numbness and impaired balance. He had been treated with metronidazole for six months for osteomyelitis of the right hallux. Examination revealed encephalopathy, and glove-and-stocking sensory loss to pinprick with reduced vibration threshold at the toe. The gait was wide based and ataxic. Nerve conduction studies showed a large fibre sensory-motor axonal polyneuropathy. Magnetic resonance imaging (MRI) revealed a solitary restricted diffusion lesion in the splenium of the corpus callosum (Figure A, B) with subtle prolongation of T2 (Figure C). The radiographic differential diagnosis included hypoglycaemia, viral encephalitis, antiepileptic drug toxicity/withdrawal and metronidazole toxicity. The combination of the imaging finding with the history of prolonged metronidazole use suggested metronidazole induced encephalopathy.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 512 - 513
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1 Gallucci, M, Limbucci, N, Paonessa, A, Caranci, F. Reversible focal splenial lesions. Neuroradiology. 2007 Jul;49:541–4.Google Scholar
2 Kim, E, Na, DG, Kim, EY, Kim, JH, Son, KR, Chang, KH. MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol. 2007 Oct;28: 1652–8.Google Scholar
3 Cecil, KM, Halsted, MJ, Schapiro, M, Dinopoulos, A, Jones, BV. Reversible MR imaging and MR spectroscopy abnormalities in association with metronidazole therapy. J Comput Assist Tomogr. 2002 Nov;26:948–51.CrossRefGoogle Scholar
4 Heaney, CJ, Campeau, NG, Lindell, EP. MR imaging and diffusionweighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity. AJNR Am J Neuroradiol. 2003 Sep;24: 1615–17.Google Scholar
5 Kim, DW, Park, JM, Yoon, BW, Baek, MJ, Kim, JE, Kim, S. Metronidazole-induced encephalopathy. J Neurol Sci. 2004 Sep 15;224:107–11.Google Scholar
6 Lee, SS, Cha, SH, Lee, SY, Song, CJ. Reversible inferior colliculus lesion in metronidazole-induced encephalopathy: magnetic resonance findings on diffusion-weighted and fluid attenuated inversion recovery imaging. J ComputAssist Tomogr. 2009 Mar; 33:305–8.Google Scholar
7 Seok, JI, Yi, H, Song, YM, Lee, WY. Metronidazole-induced encephalopathy and inferior olivary hypertrophy: lesion analysis with diffusion-weighted imaging and apparent diffusion coefficient maps. Arch Neurol. 2003 Dec;60:1796–800.CrossRefGoogle ScholarPubMed
8 Groothoff, MV, Hofmeijer, J, Sikma, MA, Meulenbelt, J. Irreversible encephalopathy after treatment with high-dose intravenous metronidazole. Clin Ther. 2010 Jan;32:60–4.Google Scholar
9 De Bleecker, JL, Leroy, BP, Meire, VI. Reversible visual deficit and Corpus callosum lesions due to metronidazole toxicity. Eur Neurol. 2005;53:93–5.CrossRefGoogle ScholarPubMed
10 Scharer, K. [Selective alterations of Purkinje cells in the dog after oral administration of high doses of nitroimidazole derivatives (author’s transl)]. Verh Dtsch Ges Pathol. 1972;56:407–10.Google Scholar
11 Bradley, WG, Karlsson, IJ, Rassol, CG. Metronidazole neuropathy. Br Med J. 1977 Sep 3;2:610–11.Google Scholar
12 Placidi, GF, Masuoka, D, Alcaraz, A, Taylor, JA, Earle, R. Distribution and metabolism of 14C-metronidazole in mice. Arch Int Pharmacodyn Ther. 1970 Nov;188:168–79.Google Scholar
13 Rao, DN, Mason, RP. Generation of nitro radical anions of some 5- nitrofurans, 2- and 5-nitroimidazoles by norepinephrine, dopamine, and serotonin. A possible mechanism for neurotoxicity caused by nitroheterocyclic drugs. J Biol Chem. 1987 Aug 25;262:11731–6.CrossRefGoogle ScholarPubMed
14 Zuccoli, G, Pipitone, N, Santa, CD. Metronidazole-induced and Wernicke encephalopathy: two different entities sharing the same metabolic pathway? AJNR Am J Neuroradiol. 2008 Oct;29:E84.Google Scholar