title: Metronidazole-induced Encephalopathy: Case Report and Review Literature.
abstract: OBJECTIVE
  Neurotoxicities resulting from various medications are under diagnosed; Metronidazole-induced encephalopathy is one of them. Here we present two patients with a history of metronidazole use and discuss neuroimaging findings.
  
  
  METHODS
  We report two patients suffering from acute neurological symptoms associated with metronidazole use. A 70-year-old female who received a cumulative dose of 41.25g of metronidazole within one month, developed seizure. Brain magnetic resonance imaging (MRI) showed T2 hyperintensity over bilateral dentate nuclei and dorsal midbrain. A 56-year-old female suffering from acute onset of central vertigo with metronidazole use, took a total dose of 24g. The brain MRI showed T2 hyperintensity over dorsal midbrain and dorsal medulla, which disappeared in the following neuroimaging 50 days later. Metronidazole-induced encephalopathy (MIE) was suspected in both patients.
  
  
  CONCLUSIONS
  Metronidazole-induced encephalopathy is an uncommon but potentially reversible disease in patients with acute neurological deficits from the use of metronidazole. Nonalcoholic Wernicke's encephalopathy may share a similar metabolic pathway with MIE, resulting in difficulties in diagnosis.
authors.affiliation: Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ying-Ting
authors.initials: YT
authors.lastname: Huang
authors.forename: Lu-An
authors.initials: LA
authors.lastname: Chen
authors.forename: Shin-Jung
authors.initials: SJ
authors.lastname: Cheng
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008636:Mesencephalon / Q000378:metabolism; D008795:Metronidazole / Q000009:adverse effects*; D008875:Middle Aged; D011838:Radiation-Sensitizing Agents / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy; D014899:Wernicke Encephalopathy / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D011838:Radiation-Sensitizing Agents; D008795:Metronidazole