January 28, 2013
A 69-year-old woman with chronic alcoholism and sudden onset of dysarthria. History of being treated for acute infectious diarrhea.
Metronidazole-Induced Toxic Encephalopathy
- Uncommon disease entity. Usually associated with high-dose IV Metronidazole administered for severe infections such as intra-abdominal abscess and sepsis.
- Patients present with dysarthria, gait disturbance, weakness of extremities, and mental confusion.
- Pathogenesis: Not completely understood. Purkinje cell damage and axonal degeneration have been proposed.
- Key Diagnostic Features: MRI demonstrates bilateral symmetric T2/FLAIR hyperintensities involving the dentate nuclei and superior colliculi. Commonly, the splenium of the corpus callosum is involved. Occasionally, though not always, diffusion restriction can be seen.
- DDx: Cerebrotendious xanthomatosis; cerebral histiocytosis; PRES
- Rx: Discontinue treatment with Metronidazole.
