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Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy
Rupinder Singh1, Ramanjeet Kaur2, Pawan Pokhariyal3
1Department of Neuroradiology, Sri Bala Ji Action Medical Institute, New Delhi, India.
Abstract:
Metronidazole-induced neuro-toxicity, though rare, is known. A characteristic spatial distribution of lesions in cerebellar dentate nuclei and dorsal pons is known. However, temporal progression of lesions on magnetic resonance imaging (MRI) has not been described previously. We describe two such cases which presented initially with splenial hyperintesity and showed progression to characterstic lesions. Both cases improved with stoppage of metronidazole.
Insights
Metronidazole neurotoxicity, while rare, can cause characteristic brain lesions. This study describes the temporal progression of these lesions on MRI, showing initial splenial hyperintensity followed by typical patterns.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Metronidazole is an antibiotic with known, though rare, neurotoxic potential.
- Characteristic lesion patterns in the cerebellar dentate nuclei and dorsal pons are documented.
- The temporal evolution of these MRI lesions has not been previously detailed.
Purpose of the Study:
- To describe the temporal progression of metronidazole-induced neurotoxicity on magnetic resonance imaging (MRI).
- To document the initial presentation and subsequent evolution of characteristic lesions.
Main Methods:
- Case study of two patients experiencing metronidazole neurotoxicity.
- Serial magnetic resonance imaging (MRI) to observe lesion development over time.
Main Results:
- Both cases initially presented with splenial hyperintensity on MRI.
- Lesions subsequently progressed to the characteristic pattern in the cerebellar dentate nuclei and dorsal pons.
- Clinical improvement was observed in both patients after discontinuing metronidazole.
Conclusions:
- Metronidazole-induced neurotoxicity can present with initial splenial hyperintensity before evolving into characteristic lesions.
- Serial MRI is valuable for understanding the temporal dynamics of this rare adverse effect.
- Discontinuation of metronidazole leads to improvement.
