J Korean Neurosurg Soc.  2012 Sep;52(3):273-276.

Atypical Metronidazole-Induced Encephalopathy in Anaerobic Brain Abscess

• Jang HJ
• Sim SY
• Lee JY
• Bang JH

Abstract

Metronidazole-induced encephalopathy is a very rare complication of the long standing use of metronidazole. The encephalopathy is bilateral and symmetric in nature. We report on the magnetic resonance imaging (MRI) and clinical course of metronidazole-induced encephalopathy in a 60-year-old female with a persistent anaerobic brain abscess after draining of the abscess. After 3 months of metronidazole administration, the patient complained of dysarthria, tingling sense of all extremities, and left hemiparesis. MRI revealed symmetric hyperintensity lesions in medulla, pons, dentate nuclei of cerebellum, and splenium of corpus callosum, all of which represent typical findings of metronidazole-induced encephalopathy. In addition, asymmetric lesions in midbrain, thalamus, putamen and cerebral subcortical white matter were noted. The patient recovered after discontinuation of metronidazole and the remaining abscess was successfully treated with meropenem and levofloxacine.

Keyword

Brain abscess; Metabolic encephalopathy; Magnetic resonance imaging; Metronidazole

MeSH Terms

Abscess
Brain
Brain Abscess
Brain Diseases, Metabolic
Cerebellum
Corpus Callosum
Dysarthria
Extremities
Female
Humans
Magnetic Resonance Imaging
Mesencephalon
Metronidazole
Middle Aged
Ofloxacin
Paresis
Pons
Putamen
Thalamus
Thienamycins
Metronidazole
Ofloxacin
Thienamycins

Figure

• 

  Fig. 1 Initial brain magnetic resonance image showing a ring-enhanced brain abscess in the left frontal lobe.

• 

  Fig. 2 Fluid attenuated inversion recovery magnetic resonance images after 84 days of metronidazole administration. Symmetric round shaped high-signal intensity at the dorsal medullae, the dentate nuclei (A), and the pons (B) and symmetric involvement along the splenium (E) are apparent. Note multiple asymmetric lesions in midbrain (C), thalamus (D), putamen (E) and subcortical white matter on right side of the brain (F). Diffuse signal change due to previous brain abscess is observed on left frontal area.

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