Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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September 28, 2017
Metronidazole-Induced Encephalopathy
- Background:
- Metronidazole-induced encephalopathy is a rare encephalopathy that may occur after administration of metronidazole.
- Clinical Presentation:
- Ataxic gait, nausea, vomiting, vertigo, dysarthria, and confusion
- Key Diagnostic Features:
- Bilateral symmetric T2 hyperintense lesions in cerebellar dentate nuclei
- Lesions in midbrain, dorsal pons, medulla, splenium of the corpus callosum, and cerebral white matter may be present.
- Differential Diagnoses:
- Symmetric signal abnormalities in the cerebellar dentate nuclei and basal ganglia:
- Toxic poisoning: carbon monoxide, methanol, cyanide
- Systemic metabolic abnormalities: hypoglycemia, electrolyte imbalance, pontine myelinolysis, Wernicke encephalopathy
- Degenerative diseases: Huntington, Leigh, Wilson, Creutzfeldt-Jakob, and Fahr disease
- Venous infarction or arterial occlusion
- Focal inflammatory/infectious conditions: Behçet disease, flavivirus encephalitis, toxoplasmosis
- Transient abnormalities in the splenium:
- Drugs: abrupt change in antiepileptic drugs, antibiotics
- Systemic abnormalities: hypoglycemia, electrolyte imbalance, pontine myelinolysis
- Disseminated encephalomyelitis (rotavirus, influenza)
- High altitude sickness
- Symmetric signal abnormalities in the cerebellar dentate nuclei and basal ganglia:
- Treatment:
- Symptoms and imaging findings normalize following cessation of metronidazole therapy.
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