Metronidazole Induced Encephalopathy: Imaging of an Unusual Side Effect
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 1
Abstract
Purpose: Metronidazole is one of the most common drug routinely prescribed for anaerobic and helminthic infections. It is commonly used to treat amebiasis, giardiasis, trichomonas, H.pylori and clostridial infections. Minor side effects like nausea, vomiting, metallic taste in the mouth, headache and abdominal pain may be seen after oral administration. Intravenous administration may cause thrombophlebitis. Rare serious side effects like neutropenia, leukopenia, central nervous system toxicity and peripheral neuropathy can be seen after prolonged and high dose treatment with metronidazole. Many of the times this metronidazole induced complication of central nervoussystem toxicity is under diagnosed due to difficulty in establishing the diagnosis. We here report acase of metronidazole induced encephalopathy and discuss its neuro imaging findings. Case Report: A 50 year old male presented with history of difficulty in walking, mental confusion, slurred speech and double vision. History revealed that he was prescribed metronidazole 50 days back which he has been taking since then (cumulative dose - approximately 60 grams). MRI showed bilaterally symmetrical T2/FLAIR hyper-intensities in dentate nuclei. Other differential diagnosis like wernicke’s encephalopathy was ruled by estimation of serum thaimine levels. Metronidazole was discontinued immediately. After discontinuation of metronidazole patient starting improving clinically. A follow up MRI after 20 days of discontinuation of metronidazole showed complete resolution of altered signal intensity areas involving dentate nuclei. Conclusion: Though rare, metronidazole-induced encephalopathy, is a serious but potentially reversible side effect of prolonged and high dose intake of metronidazole. Acute central nervous system toxicity caused by metronidazole may closely mimic wernicke’s encephalopathy. Characterstic neuro imaging findings along with normal thiamine levels confirm the diagnosis of metronidazoleinduced encephalopathy.
Authors and Affiliations
Dr Abhishek Jain
Keywords
Related Articles
- EP ID EP273222
- DOI -
- Views 93
- Downloads 0
Comparison between clinical and ultrasound finding in patients with vitreous hemorrhage
Vitreous hemorrhage is defined as extravasation of blood into one of the several potential spaces formed within and around the vitreous body1 . Vitreous hemorrhage can be caused by the pathological mechanisms like disrup...
Functional Outcome of Surgical Management of Non Union Scaphoid Fracture
Background: Incidence of scaophoid fracture non union is estimated to be 5-10% despite treatment. Considering the poor prognosis, a number of treatments have been advocated. Though literature supports open reduction, int...
Neonatal Mortality Rate in the Special Care Baby Unit
The aim of this retrospective study was to determine the incidence and risk factors of neonatal mortality among cases admitted to SCBU at Gharian Teaching Hospital . The study included all admitted newborn cases to the S...
To Study the Intraocular Pressure and Blood Pressure Changes in Pre and Post-Menopausal Indian Women
Normal Intraocular pressure (IOP) is an essential prerequisite for the eye to serve its function as a light gathering and transducer organ. Various physiological factors which include age, gender and hormonal variations...
Evaluation of Left Ventricular Diastolic Dysfunction in Asymptomatic Normotensive Patients with Type-2 Diabetes Mellitus
Introduction: Diabetes mellitus (DM) is known to affect cardiovascular system adversely. Various studies reported left ventricular diastolic dysfunction (LVDD) as an early sign of cardiac involvement in asymptomatic pati...