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http://dx.doi.org/10.3340/jkns.2012.52.3.273

Atypical Metronidazole-Induced Encephalopathy in Anaerobic Brain Abscess  

Jang, Han Jin (Department of Neurosurgery, National Medical Center)
Sim, Sook Young (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine)
Lee, Jong Yun (Department of Neurology, National Medical Center)
Bang, Ji Hwan (Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.52, no.3, 2012 , pp. 273-276 More about this Journal
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.
Keywords
Brain abscess; Metabolic encephalopathy; Magnetic resonance imaging; Metronidazole;
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Times Cited By Web Of Science : 0  (Related Records In Web of Science)
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1 Kim E, Na DG, Kim EY, Kim JH, Son KR, Chang KH : MR imaging of metronidazole-induced encephalopathy : lesion distribution and diffusion- weighted imaging findings. AJNR Am J Neuroradiol 28 : 1652- 1658, 2007   DOI   ScienceOn
2 Lamp KC, Freeman CD, Klutman NE, Lacy MK : Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clin Pharmacokinet 36 : 353-373, 1999   DOI   ScienceOn
3 Lee SS, Cha SH, Lee SY, Song CJ : Reversible inferior colliculus lesion in metronidazole-induced encephalopathy : magnetic resonance findings on diffusion-weighted and fluid attenuated inversion recovery imaging. J Comput Assist Tomogr 33 : 305-308, 2009   DOI   ScienceOn
4 Rao DN, Mason RP : Generation of nitro radical anions of some 5-nitrofurans, 2- and 5-nitroimidazoles by norepinephrine, dopamine, and serotonin. A possible mechanism for neurotoxicity caused by nitroheterocyclic drugs. J Biol Chem 262 : 11731-11736, 1987
5 Seok JI, Yi H, Song YM, Lee WY : Metronidazole-induced encephalopathy and inferior olivary hypertrophy : lesion analysis with diffusionweighted imaging and apparent diffusion coefficient maps. Arch Neurol 60 : 1796-1800, 2003   DOI   ScienceOn
6 Woodruff BK, Wijdicks EF, Marshall WF : Reversible metronidazoleinduced lesions of the cerebellar dentate nuclei. N Engl J Med 346 : 68- 69, 2002   DOI   ScienceOn
7 Ahmed A, Loes DJ, Bressler EL : Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy. Neurology 45 : 588-589, 1995   DOI   ScienceOn
8 Bahn Y, Kim E, Park C, Park HC : Metronidazole induced encephalopathy in a patient with brain abscess. J Korean Neurosurg Soc 48 : 301- 304, 2010   DOI   ScienceOn
9 Bonkowsky JL, Sondrup C, Benedict SL : Acute reversible cerebellar lesions associated with metronidazole therapy. Neurology 68 : 180, 2007   DOI   ScienceOn
10 Cecil KM, Halsted MJ, Schapiro M, Dinopoulos A, Jones BV : Reversible MR imaging and MR spectroscopy abnormalities in association with metronidazole therapy. J Comput Assist Tomogr 26 : 948-951, 2002   DOI   ScienceOn
11 Cottagnoud P, Cottagnoud M, Acosta F, Flatz L, Kuhn F, Stucki A, et al. :Meropenem prevents levofloxacin-induced resistance in penicillin-resistant pneumococci and acts synergistically with levofloxacin in experimental meningitis. Eur J Clin Microbiol Infect Dis 22 : 656-662, 2003   DOI   ScienceOn
12 De Bleecker JL, Leroy BP, Meire VI : Reversible visual deficit and Corpus callosum lesions due to metronidazole toxicity. Eur Neurol 53 : 93- 95, 2005   DOI   ScienceOn
13 Glupczynski Y, Berhin C, Nizet H : Antimicrobial susceptibility of anaerobic bacteria in Belgium as determined by E-test methodology. Eur J Clin Microbiol Infect Dis 28 : 261-267, 2009   DOI   ScienceOn
14 Hammami N, Drissi C, Sebai R, Araar M, Maatallah Y, Belghith L, et al. : Reversible metronidazole-induced encephalopathy. J Neuroradiol 34 : 133-136, 2007   DOI   ScienceOn
15 Heaney CJ, Campeau NG, Lindell EP : MR imaging and diffusionweighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity. AJNR Am J Neuroradiol 24 : 1615-1617, 2003
16 Kim DW, Park JM, Yoon BW, Baek MJ, Kim JE, Kim S : Metronidazoleinduced encephalopathy. J Neurol Sci 224 : 107-111, 2004   DOI   ScienceOn
17 Horlen CK, Seifert CF, Malouf CS : Toxic metronidazole-induced MRI changes. Ann Pharmacother 34 : 1273-1275, 2000   DOI