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

A Case Report of Status Myoclonic Seizure after Spinal Anesthesia with Tetracaine / 대한마취과학회지

The subarachnoid injection of local anesthetics to obtain lower limbs anesthesia has been used since 1899 by first August Bier. Transient neurologic complications during and immediately after spinal anesthesia are rare ; however we recently encountered a case of CNS toxicity that was nonspecific and severe in a 30 year old man who had a hemiorrhaphy under spinal anesthesia using tetracaine with epinephrine. The exact cause of seizure attack was unknown, but we suspected it tetracaine induced CNS toxicity due to vascular absorption or cephalard movement in CSF.

A Case Report of Central Nervous System Toxicity following Accidental Injection of Tranexamic acid into Subarachnoid space / 대한마취과학회지

Neurologic Sequelae after spinal anesthesia are extrenely rare, due in part to use of prepackaged and sterile kits and the small doses of local anesthectics employed. We have experienced 42 years old healthy male developed cental nervous system toxicity due to injection of wrong substance into subarachnoid space. And the patient recovered 3 days later with mild pulmonary edema and about 72 hour anterograde amnesia after symptomatic treatment.