Metronidazole-Induced Encephalopathy (MIE)

Metronidazole is an antibiotic often used to treat bacterial infections in the vagina, skin, liver, stomach, joints, brain and spinal cord, heart, lungs, or bloodstream. It is an essential drug for treating anaerobic bacterial infections, microaerophilic bacterial infections, and protozoal infections. It is cytotoxic to many facultative anaerobic microorganisms. Metronidazole can be taken by most children and adults but might not be suitable for some people. It may produce different neurologic side effects like cerebellar dysfunction, peripheral neuropathy, vestibulotoxicity, visual impairment, encephalopathy, ataxic gait, seizures, dysarthria, and cochleotoxicity. We report a case of a gentleman in his early 60s with a liver abscess and a history of three weeks of use of metronidazole therapy presenting with altered sensorium, abnormal gait, and slurring of speech. MRI brain showed bilateral symmetrical hyperintensities involving the dentate nuclei of the cerebellum and dorsal brain stem without evidence of any diffusion restriction suggestive of metronidazole-induced encephalopathy (MIE).