Article Figures & Data
Figures
- Fig 1.
A 54-year-old man (patient 4) with spontaneous bacterial peritonitis. A, Axial FLAIR (TR/TE/TI = 6000/120/2000 ms) images demonstrate bilateral symmetric hyperintense lesions in the dorsal medulla (black thick arrows), vestibular (black thin arrows), abducens (white arrows), and a focal tegmental lesion of the superior olivary nuclei (arrowheads) of the dorsal pons, dentate nuclei of the cerebellum, red nuclei and tegmentum of the midbrain, and the splenium of the corpus callosum. B, DWIs (TR/TE = 3396/60) show bright signal intensity at the peripheral part of the cerebellar dentate nuclei and central part of the splenium. The lesions of the low pons and tegmentum of the midbrain are slightly hyperintense, and the lesions of dorsal medulla and central part of dentate nuclei are isointense on DWI. C, ADC maps show a focal area of low ADC in the splenium of the corpus callosum (black arrow) and a high ADC area in most areas of the dentate nuclei (white arrows).
- Fig 2.
A 55-year-old man with ischemic colitis (patient 6). A, Axial T2-weighted (TR/ TE = 5000/110) images demonstrate bilateral symmetric hyperintense lesions in the dorsal medulla, vestibular, abducens, and focal tegmental lesions of the superior olivary nuclei of the dorsal pons, dentate nuclei of the cerebellum, the tectum of the midbrain, and the splenium of the corpus callosum. B, DWI (TR/TE = 4000/73) and ADC maps show mild hyperintensity and slightly high ADC of the dentate nuclei and obvious hyperintensity and very low ADC of the splenium of the corpus callosum. C, Follow-up MR images obtained 15 days after drug discontinuation. T2-weighted images show that the hyperintense lesions of the dentate nucleus and pons have disappeared, but a residual hyperintense lesion is seen in the splenium of corpus callosum. Note the near normalization of ADC and residual hyperintensity of the residual splenium lesion on DWI.
- Fig 3.
A 64-year-old man with an intra-abdominal abscess (patient 3). A, Axial FLAIR (TR/TE/TI = 10,000/122/2000) images show bilateral symmetric hyperintense lesions in the inferior olivary nuclei (arrows) and dorsal medulla, dorsal pons, cerebellar dentate nuclei, splenium and genu of corpus callosum, and subcortical white matter of both cerebral hemispheres. B, Follow-up FLAIR images obtained 17 days after drug discontinuation show complete reversal of all lesions.
Tables
Patient Age/Sex Underlying Disease Drug Dosage (g)/Duration (days) Symptoms Medication Duration Before Symptom Development (days) Time to Clinical Improvement after Drug Discontinuation (days) Duration Between Symptom Onset and Initial MRI (days) Duration Between Drug Discontinuation and Follow-Up MRI (days)a 1 49/M Crohn disease 135/90 Weakness of extremities, dysarthria, gait disturbance 52 10 38 – 2 70/M Brain abscess, LC 57/38 Weakness of extremities, dysarthria 22 7 7 14 3 64/M Intraabdominal abscess 37.5/25 Dysarthria, gait disturbance, visual blurring 17 7 17 17 4 54/M Spontaneous bacterial peritonitis, LC 49.5/33 Dysarthria, confusion 15 5 21 – 5 71/M DM foot, CRF 66/44 Dysarthria, gait disturbance 37 4 3 34 6 55/M Ischemic colitis, LC 21/14 Dysarthria, gait disturbance, tingling sensation of both extremities 11 7 3 15 7 61/F Pseudo-membranous colitis 40.5/27 Dysarthria, gait disturbance 24 7 5 – Note:—LC indicates liver cirrhosis; CRF, chronic renal failure; DM, diabetes mellitus.
a Follow-up MR imaging was not studied in 3 patients (patients 1, 4, and 7).
- Table 2:
Lesion distribution on T2-weighted and FLAIR MR images in the seven patients with MIE
Patient Cerebellum (Dentate Nuclei) Medulla Pons Midbrain Corpus Callosum Subcortical WM Dorsal Medulla ION VN AN SON Tectum Tegmentum RN 1 + − − + + + − + + − − 2 + − − + − + + + + + − 3 + + + + − + + + − + + 4 + + − + + + − + + + − 5 + + − + + + + − − − − 6 + + − + + + + − − + − 7 + − − − − − + − − − − Note:—WM indicates white matter; ION, inferior olivary nucleus; VN, vestibular nucleus; AN, abducens nucleus; SON, superior olivary nucleus; RN, red nucleus; +, presence of lesion at each anatomic location; −, no abnormality on MR at each anatomic location.
- Table 3:
Signal intensities and ADC values of lesions of DWI on initial MR imaging in five patients and follow-up MR imaging in one patient
Lesions Signal Intensity on DWI (High/Mixed/Iso) ADC Value (10−6 mm2/s) ADC Ratioa Initial patients (n = 5) Cerebellar dentate nucleus (n = 5) 2/2/1 885 ± 67 1.2 ± 0.06 Midbrain (n = 5) Tectum (n = 3) 2/0/1 872 ± 59 1.1 ± 0.10 Red nucleus (n = 2) 1/1/0 929 ± 2 1.3 ± 0.01 Tegmentum around peri-aqueductal GM (n = 2) 2/0/0 1021 ± 59 1.5 ± 0.09 Dorsal pons (n = 4) 2/0/2 844 ± 75 1.1 ± 0.16 Dorsal medulla (n = 3) 1/1/1 959 ± 162 1.3 ± 0.25 Splenium (n = 2) 2/0/0 515 ± 195 0.7 ± 0.30 Follow-up patient (n = 1) Cerebellar dentate nucleus (n = 1) (0/0/1) 734 1.0 Splenium (n = 1) (1/0/0) 1097 1.4 Note:—Iso indicates isointense; GM, gray matter.
a ADC values and ratios are presented as mean ± SD. ADC ratio is the ratio of the ADC value of a lesion to that of normal subcortical white matter.
In this issue
Jump to section
Related Articles
Cited By...
- Potentially Reversible and Recognizable Acute Encephalopathic Syndromes: Disease Categorization and MRI Appearances
- Acute Toxic Leukoencephalopathy: Etiologies, Imaging Findings, and Outcomes in 101 Patients
- A case of metronidazole-induced neurotoxicity
- An 82-year-old man with ataxia and dysarthria
- Mystery Case: Metronidazole-induced encephalopathy
- Antibiotic-associated encephalopathy
- MR features of metronidazole-induced encephalopathy
- Acute cerebellar syndrome associated with metronidazole
- Metronidazole-induced encephalopathy after prolonged metronidazole course for treatment of C. difficile colitis
- Metronidazole and Hydroxymetronidazole Central Nervous System Distribution: 1. Microdialysis Assessment of Brain Extracellular Fluid Concentrations in Patients with Acute Brain Injury
- Metronidazole and Hydroxymetronidazole Central Nervous System Distribution: 2. Cerebrospinal Fluid Concentration Measurements in Patients with External Ventricular Drain
- Radiographic evolution of a rapidly reversible leukoencephalopathy due to metronidazole
- Brain MRI evolution of metronidazole intoxication
- Central Nervous System Involvement in Adults with Epidemic Hemolytic Uremic Syndrome
- Walking unsteadily: a case of acute cerebellar ataxia
- Hypertrophic olivary degeneration in children: four new cases and a review of the literature with an emphasis on the MRI findings
- Painful neuropathy due to skin denervation after metronidazole-induced neurotoxicity
- MRI of metronidazole induced cerebellar ataxia
- Reversible cerebellar syndrome caused by metronidazole
- Heat Stroke: Increased Signal Intensity in the Bilateral Cerebellar Dentate Nuclei and Splenium on Diffusion-Weighted MR Imaging
- Characterizing the Mesencephalon Using Susceptibility-Weighted Imaging
- MR Imaging Findings in 56 Patients with Wernicke Encephalopathy: Nonalcoholics May Differ from Alcoholics