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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

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