Neurotoxicidad secundaria a metronidazol: un efecto adverso reversible. Caso clínico / Reversible neurotoxicity secondary to metronidazole report of one case

Metronidazole can cause adverse effects both in the central and peripheral nervous system. We report a 34-year-old female who presented a reversible cerebellar syndrome and peripheral neuropathy as an adverse effect associated with the use of metronidazole. Brain magnetic resonance imaging (MRI) showed hyperintense T2 and FLAIR bilateral symmetrical cerebellar lesions, without contrast enhancement or mass effect, isointense in diffusion-weighted imaging and hypointense in apparent diffusion coefficient sequences. Also, electrophysiological evaluation was consistent with axonal polyneuropathy. She had received metronidazole for a liver abscess during 49 days. After discontinuation of metronidazole, she had rapid regression of cerebellar symptoms and normalization of MRI, with subsequent disappearance of peripheral symptoms. The brain MRI, electromyography and nerve conduction studies performed at 35 months later showed complete resolution of the lesions. Although metronidazole neurotoxicity is a rare event, it must be borne in mind because the prognosis is usually favorable after stopping the drug.

Cerebellar Nocardiosis and Myopathy from Long-Term Corticosteroids for Idiopathic Thrombocytopenia

Infection of the central nervous system with Nocardia sp. usually manifests as supratentorial abscesses. Supratentorial and cerebellar abscesses from infection with Nocardia sp. following immunosuppression with long-term corticosteroids for idiopathic thrombocytopenia (ITP) have not been reported. An 83 years-old, human immunodeficiency virus (HIV)-negative, polymorbid male with ITP for which he required corticosteroids since age 53 years developed tiredness, dyspnoea, hemoptysis, abdominal pain, and progressive gait disturbance. Imaging studies of the lung revealed an enhancing tumour in the right upper lobe with central and peripheral necrosis, multiple irregularly contoured hyperdensities over both lungs, and right-sided pleural effusions. Sputum culture grew Nocardia sp. Neurological diagnostic work-up revealed dysarthria, dysphagia, ptosis, hypoacusis, tremor, dysdiadochokinesia, proximal weakness of the lower limbs, diffuse wasting, and stocking-type sensory disturbances. The neurological deficits were attributed to an abscess in the upper cerebellar vermis, myopathy from corticosteroids, and polyneuropathy. Meropenem for 37 days and trimethoprime-sulfamethoxazole for 3 months resulted in a reduction of the pulmonary, but not the cerebral lesions. Therefore, sultamicillin was begun, but without success. Long-term therapy with corticosteroids for ITP may induce not only steroid myopathy but also immune-incompetence with the development of pulmonary and cerebral nocardiosis. Cerebral nocardiosis may not sufficiently respond to long-term antibiotic therapy why switching to alternative antibiotics or surgery may be necessary.

Encefalopatía dialítica: revisión actualizada y comunicación de 6 casos clínicos / Dialysis encephalopathy: up-to-date and report of 6 clinical cases

En el presente trabajo se realiza una puesta al día de la Encefalopatía o Demencia Dialítica (ED) trastorno neurológico de gran interés, eminentemente asociado a la hemodiálisis crónica. Se revisan las diversas etiologías implicadas, destacando en particular la toxicidad por aluminio como causa de mayor relevancia a la luz de la información actual. Se describe el cuadro clínico en extensión, con sus variadas manifestaciones semiológicas, su evolución, los estudios complementarios de mayor utilidad en su diagnóstico, los hallazgos neuropatológicos, los variados diagnósticos diferenciales, así como las medidas profilácticas y terapéuticas pertinentes. Además, se establecen algunos alcances con patologías asociadas tanto a la ED como a la toxicidad por aluminio. Finalmente se presentan 6 casos clínicos documentados estudiados por el autor, con especial énfasis en su expresión clínica, su evolución, los hallazgos del laboratorio, las terapias aplicadas y su relación con elevadas concentraciones de alumninio en la solución de diálisis como en el suero de los pacientes