MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings.
OBJECTIVE
MR imaging features of metronidazole-induced encephalopathy (MIE) have not been fully established. This study was undertaken to determine the topographic distributions and diffusion-weighted imaging (DWI) findings of MIE.


METHODS
We retrospectively evaluated the initial MR images (n = 7), including DWI (n = 5), and follow-up MR images (n = 4) after drug discontinuation in 7 patents with clinically diagnosed MIE. The topographic distributions of lesions were evaluated on MR images, and DWI signal intensities and apparent diffusion coefficient (ADC) values of the lesions were assessed.


RESULTS
MR images demonstrated bilateral symmetric T2 hyperintense lesions in the cerebellar dentate nucleus (n = 7), midbrain (n = 7), dorsal pons (n = 6), medulla (n = 4), corpus callosum (n = 4), and cerebral white matter (n = 1). Brain stem lesions involved the following: tectum (n = 5), tegmentum (n = 4), red nucleus (n = 3) of the midbrain, vestibular nucleus (n = 6), and a focal tegmental lesion involving the superior olivary nucleus (n = 6) and abducens nucleus (n = 4) of the pons and vestibular nucleus (n = 4) and inferior olivary nucleus (n = 1) of the medulla. DWI (n = 5) showed isointensity or hyperintensity of lesions, and the decreased ADC value was found only in the corpus callosum lesions (n = 2). All detected lesions were completely reversible at follow-up except for the single corpus callosum lesion with an initial low ADC value.


CONCLUSIONS
Brain lesions were typically located at the cerebellar dentate nucleus, midbrain, dorsal pons, medulla, and splenium of the corpus callosum. According to DWI, most of the lesions in MIE probably corresponded to areas of vasogenic edema, whereas only some of them, located in the corpus callosum, corresponded to cytotoxic edema.
Kim
E
E
Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
Na
D G
DG
Kim
E Y
EY
Kim
J H
JH
Son
K R
KR
Chang
K H
KH
D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008795:Metronidazole / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies
D000890:Anti-Infective Agents; D008795:Metronidazole