[Sensory aphasia during therapy with metronidazole--an important differential diagnosis of acute cerebral ischemia]

A 74-year old man was admitted after neurosurgical treatment of a lumbar vertebral fracture. He had a slight paresis of the right leg in combination with bladder dysfunction.

There were signs of a postoperative anemia (hemoglobin 10.4 mg/dl) and mildly elevated infection parameters (CRP 2 mg/dl). Routine ECG and chest X-ray were normal.

Physical training was initiated, but diarrhea occurred 2 days after admission. As the patient had received antibiotics after the operation, a treatment with metronidazole was initiated under the suspicion of diarrhoea induced by clostridium difficile. At day 6 of treatment a hypertensive crisis (blood pressure 230/120 mmHg) developed, followed by sensory aphasia. Despite treatment at the stroke unit and blood pressure regulation, the clinical signs of aphasia persisted. MRI could not detect an acute cerebral infarction. After discontinuation of metronidazole complete reconstitution occurred within 72 h.

Metronidazole should be taken into account as cause of severe neurological side effects including ischemia-like syndromes like aphasia.