Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement

Computed Tomography Scan And Therapeutic Response In Patients With Neurocysticercosis.

Neurocysticercosis (NCC) is the most common parasitic disease of the nervous system with varied clinical and imaging spectrum. This study was conducted to describe the clinical , CTfinding and response to therapy of NCC. Materials: Hundred (100) patients of NCC presenting in department of medicine, PMCH, Patna were evaluated on preset proforma containing detailed demographic data, dietary habits, clinical features and neuroimaging findings and its therapeutic response. Patients were treated with 28 days course of albendazole and repeat CTscan was done in 2 months after treatment. Results: Out of 100 patients of NCC, 56 (56%) were male with most common age group being 21-30 years (36%). Only Seizure is the most common presentation followed by Seizure with featuers of increased intracranial pressure (70 and 14% respectively). Multiple ring enhancing lesions either alone or in combination were seen on computerised tomography scans in 56 (56%) cases and parietal lobe involvement is the commonest site. Complete resolution of CTscan lesions in 72 (72%) and partial resolution occurred in rest of patients. Conclusions: Neurocysticercosis is common public health problem and one of the common cause of seizure. It has varied imaging finding being ring enhancement is most common. Albendazole is highly effective therapy and should be started at earliest to prevent morbidity and mortality