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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January 28, 2013
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.
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