Reversible MRI Findings in Metronidazole-induced Cerebellar Dysfunction

ABSTRACT

Metronidazole is widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections. It pro-duces a number of neurological side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. A 66-year-old male patient was admitted to our department because of a tingling sensation in both toes as well as ataxia with dizziness which had developed five prior to admission. He had had been diagnosed with hepatoma and had an operation in 1993. One month before admission, he felt a febrile sensation and was diagnosed as having abdominal abscess by an ultrasonography, and took about 30g of metronidazole until visiting our emergency room. A nerve conduc-tion test revealed sensorimotor polyneuropathy in the four extremities. A brain MRI showed symmetrically increased signal intensities without enhancement in the supratentorial white matter and the dentate nucleus of the cerebellum. After stopping metronidazole, his neurological symptoms began to improve and on the following MRI taken seven weeks later, the symmetrically increased signal intensities in the dentate nucleus of the cerebellum were nearly disappeared.