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Case Studies | Medicine | India | Volume 12 Issue 1, January 2023
An Unusual Case of Metronidazole Induced Encephalopathy
Dr. Buddhadeb Majumder | Dr. Pradeep Tiwari | Dr. Arundhati Barua | Dr. Nivedita Moulick [2]
Abstract: Introduction: Metronidazoleis a fairly well tolerated drug, however it can produce several adverse neurologic effects. The incidence of metronidazole induced encephalopathy (MIE) is uncommon. Neuroimaging manifestations of metronidazole toxicity mainly includes lesions of the Cerebellum, brain stem and corpus callosum. The first case of MIE was published way back in 1977. Since then few cases have been reported and awareness of this condition among clinicians has substantially increased, especially in the last decade. Maximum cases presented with cerebellar dysfunction followed by altered mental status and seizures. Among cerebellar dysfunction dysarthria, ataxia, dysmetria and nystagmus were most common. Altered mental status is generally a part of the encephalopathy. Withholding metronidazole as early as possible along with supportive therapy is the only proven measure. Case Report: A 77 years old male presented to our hospital with chief complaints of generalized weakness since 15 days, slurring of speech since 2 days and disoriented since the morning of admission. Patient is a case of Amoebic Liver Abscess diagnosed 10 weeks back. Patient was started on Inj Metronidazole 2.4 grams / day for the first 14 days which was then converted to Tab Metronidazole 2.4 grams / day which was continued till admission. On examination patient appeared drowsy and disoriented. Dysarthria was present. Nystagmus was present. MRI Brain showed Bilaterally Symmetrical Hyperintensities in Red Nucleus and dentate nucleus. Tab Metronidazole was Stopped and within 48 hours of stopping the drug patient sensorium improved. Conclusion: Neurotoxicity is an important but rare adverse effect of Metronidazole. Our patient developed encephalopathy following the initiation of Metronidazole at High Dose and showed complete improvement after discontinuation. This temporal relationship supports the diagnosis of Metronidazole Induced Encephalopathy.
Keywords: MIE, Metronidazole induced encephalopathy, Dentate nucleus, Neurotoxicity, Dysarthria, Amoebic liver abscess
Edition: Volume 12 Issue 1, January 2023,
Pages: 745 - 747