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• W2166831213 abstract "Metronidazole, often used for the treatment of hepatic encephalopathy, is associated with a few but rare neurologic side effects including peripheral neuropathy and cerebellar dysfunction.1Heaney C.J. Campeau N.G. Lindell E.P. MR imaging and diffusion-weighted imaging changes in metronidazole (flagyl)-induced cerebellar toxicity.AJNR Am J Neuroradiol. 2003; 24: 1615-1617PubMed Google Scholar, 2Bradley W.G. Karlsson I.J. Rassol C.G. Metronidazole neuropathy.BMJ. 1977; 2: 610-611Crossref PubMed Scopus (129) Google Scholar A 50-year-old man was admitted for treatment of subacute bacterial peritonitis and hepatic encephalopathy (HE) associated with end-stage liver disease from hepatitis C virus infection. He had a recent history of Cryptococcal meningitis. Initial neurologic examination revealed that he had somewhat slurred speech from grade I–II HE without focal neurologic deficits. However, on the 5th hospital day, while he was treated for his HE with lactulose and metronidazole (500 mg given orally 3 times/day), he developed ataxia and dysarthric speech. Laboratory values remained unchanged. Further tests including analysis of cerebrospinal fluid failed to show evidence of infection. Cryptococcal antibodies in blood and cerebrospinal fluid were not increased. A computed tomography scan of the head showed no evidence of acute intracranial abnormalities. However, a magnetic resonance image of the brain revealed bilateral enhancement of the cerebellar dentate nuclei (FigureA). A random metronidazole serum level was increased significantly at 50 mcg/mL (toxic range, >11.5 mcg/mL; dose measured 1 hour after a single dose of 500 mg by mouth; National Medical Services, Willow Grove, PA). After discontinuation of metronidazole, his dysarthria and ataxia significantly improved over the next 2 weeks. A follow-up magnetic resonance image showed marked resolution of the cerebellar dentate nuclei enhancement (FigureB). A repeat metronidazole level was 5 mcg/mL.View Large Image Figure ViewerDownload (PPT) Metronidazole crosses the blood-brain barrier and could produce toxic effects such as peripheral neuropathy, seizures, and ataxia.2Bradley W.G. Karlsson I.J. Rassol C.G. Metronidazole neuropathy.BMJ. 1977; 2: 610-611Crossref PubMed Scopus (129) Google Scholar, 3Kusumi R.K. Plouffe J.F. Wyatt R.H. et al.Central nervous system toxicity associated with metronidazole therapy.Ann Intern Med. 1980; 93: 59-60Crossref PubMed Scopus (87) Google Scholar Previous reports1Heaney C.J. Campeau N.G. Lindell E.P. MR imaging and diffusion-weighted imaging changes in metronidazole (flagyl)-induced cerebellar toxicity.AJNR Am J Neuroradiol. 2003; 24: 1615-1617PubMed Google Scholar, 2Bradley W.G. Karlsson I.J. Rassol C.G. Metronidazole neuropathy.BMJ. 1977; 2: 610-611Crossref PubMed Scopus (129) Google Scholar showed that metronidazole was associated with sharply demarcated and symmetric lesions in the brain stem, cerebellar nuclei, and spinal cord of rats resulting from axonal degeneration by binding to neuronal RNA and inhibiting protein synthesis. Prolonged administration of high doses of metronidazole in dogs has been shown to cause Purkinje cell damage.4Scharer K. Selective alterations of purkinje cells in the dog after oral administration of high doses of nitroimidazole derivatives.Verh Dtsch Ges Pathol. 1972; 56: 407-410PubMed Google Scholar The Art of Assessing Metronidazole ToxicityClinical Gastroenterology and HepatologyVol. 4Issue 9PreviewDear Editor: Full-Text PDF" @default.
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• W2166831213 date "2005-03-01" @default.
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• W2166831213 title "Abnormal enhancing lesion of dentate nuclei causing neurologic symptoms induced by metronidazole toxicity" @default.
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• W2166831213 doi "https://doi.org/10.1016/s1542-3565(04)00721-9" @default.
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