Metronidazole-Induced Encephalopathy (MIE)

Area of Science:

• Neurology
• Infectious Diseases
• Pharmacology

Background:

• Metronidazole is a crucial antibiotic for treating anaerobic, microaerophilic, and protozoal infections.
• It is effective against various bacterial infections affecting multiple organ systems.
• While generally safe, metronidazole can cause significant neurological adverse effects.

Observation:

• A liver abscess patient developed altered sensorium, abnormal gait, and dysarthria after three weeks of metronidazole therapy.
• Clinical presentation suggested a central nervous system complication.
• Neurological examination revealed symptoms consistent with cerebellar and brainstem dysfunction.

Findings:

• Brain MRI revealed bilateral symmetrical hyperintensities in the dentate nuclei and dorsal brainstem.
• These findings were indicative of metronidazole-induced encephalopathy (MIE).
• Absence of diffusion restriction on MRI supported MIE over other potential causes like stroke.

Implications:

• This case underscores the importance of recognizing metronidazole-induced encephalopathy (MIE) as a potential complication.
• Early diagnosis and discontinuation of metronidazole are crucial for managing MIE.
• Awareness of MIE is vital for clinicians managing patients on long-term or high-dose metronidazole therapy.