[Metronidazole-induced neurotoxicity]

Metronidazole, an antiparasitic treatment with bactericidal activity, may be neurotoxic. The exact pathophysiology of this complication is unknown. While it is related to the cumulative dose, it does vary from patient to patient. We are describing the case of a 43-year-old woman, who was admitted into the hospital for treatment of a liver abscess and an ascitic fluid infection. This patient presented with cerebellar syndrome and motor slowing 29 days after starting metronidazole. Cerebral MRI showed a FLAIR hypersignal of the dentate nuclei without associated enhancement or diffusion restriction. This is typical of metronidazole toxic encephalopathy. Treatment had to be stopped. The patient's clinical course rapidly improved. A follow-up MRI scan after 10 days showed the complete resolution of dentate nuclei lesions.