Investig Magn Reson Imaging.  2018 Sep;22(3):200-203. 10.13104/imri.2018.22.3.200.

A Case of Metronidazole-Induced Encephalopathy: Atypical Involvement of the Brain on MRI

• Hwang E
• Chang SK
• Lee SA
• Choi JA

• KMID: 2421554
• DOI: http://doi.org/10.13104/imri.2018.22.3.200

Abstract

Metronidazole is an antimicrobial agent widely used for the treatment of anaerobic infection or antibiotics-associated diarrhea. It is generally thought to be safe, but can induce reversible toxic encephalopathy in the case of excessive or cumulative over-dose. Metronidazole-induced encephalopathy generally demonstrates the characteristic features of typical lesion location and bilaterality on magnetic resonance imaging (MRI). We report a case of metronidazole-induced encephalopathy with the involvement of asymmetric white matter. To our knowledge, only a few cases have been reported with respect to white matter lesion characteristics on MRI with diffusion-weighted images.

Keyword

Metronidazole; White matter abnormality; Magnetic resonance imaging

MeSH Terms

Brain Diseases*
Brain*
Diarrhea
Magnetic Resonance Imaging*
Metronidazole
Neurotoxicity Syndromes
White Matter
Metronidazole

Figure

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  Fig. 1 Initial MRI of the brain of a 58-year-old woman (a–c). Diffusion-weighted imaging (b) showed multifocal high signal intensities at the genu and splenium of the bilateral corpus callosum and subcortical white matter of the left cerebral hemisphere (black and white arrows). The splenium of the corpus callosum (white arrow) showed no increased value on the apparent diffusion coefficient (ADC) map (c) and high signal intensity on a T2 fluid attenuation inversion recovery (FLAIR) image (a). The others showed a decreased value on the ADC map and isointensity on a T2 FLAIR image.

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  Fig. 2 One-week follow-up MRI of the brain after discontinuation of metronidazole (a–c). The previous lesions are markedly resolved on diffusion-weighted imaging (DWI) (b) and apparent diffusion coefficient (ADC) map (c), although the lesion in the splenium of the corpus callosum remained on a T2 fluid attenuation inversion recovery (FLAIR) image (a) and DWI.

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  Fig. 3 One-month follow-up MRI of the brain (a–c). Previously-noted lesions are nearly completely resolved.

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