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Metronidazole toxicity presenting with acute onset of aphasia and right sided weakness

Stacie L Demel1, Tudor G Jovin1, Ashutosh P Jadhav1

  • 1Department of Neurology, University of Pittsburgh Medical Center, Kaufmann Medical Building Suite 811, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|March 24, 2015
PubMed

Insights

This case study highlights metronidazole-induced leukoencephalopathy, a rare condition mimicking stroke. Prompt recognition is crucial for accurate diagnosis and treatment of neurological deficits.

Area of Science:

  • Neurology
  • Toxicology

Background:

  • A 37-year-old man with cirrhosis and Staphylococcus aureus bacteremia presented with neurological symptoms.
  • The patient had a history of Clostridium difficile infection treated with metronidazole for two months.

Observation:

  • The patient exhibited progressive confusion, aphasia, left eye deviation, and right-sided weakness.
  • Initial presentation suggested a left middle cerebral artery stroke.

Findings:

  • Magnetic Resonance Imaging (MRI) revealed leukoencephalopathy, not a stroke.
  • Metronidazole toxicity was identified as the cause of the neurological symptoms.

Implications:

  • Metronidazole-induced leukoencephalopathy should be considered in patients with acute focal neurological deficits.
  • This condition serves as a critical stroke mimic, necessitating careful differential diagnosis.
Keywords:
FlagylHemiparesisLeukoencephalopathyStroke mimic

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