title: [Reversible changes on MR images in a patient with metronidazole-induced encephalopathy].
abstract: A 66-year-old woman was diagnosed with a brain abscess. The abscess was drained by sterotactic catheter insertion. She was administered metronidazole at a dose of 2 g/day. On the 30th day of treatment, she had nausea that gradually progressed. On the 45th day, she developed a disturbance of consciousness and was admitted to our department. She was in stuporous state, and had slight vestibular and cerebellar dysfunctions. Diffusion-weighted and FLAIR brain MR images showed bilateral symmetrical high signals in the splenium of the corpus callosum (SCC), cerebellar dentate nucleus, and inferior colliculus. The apparent diffusion coefficient (ADC) map was reduced in the SCC, but not in the other locations. The peak of lactate on MR spectroscopy was increased in the SCC. The clinical presentation and image changes of the patient were thought to be most consistent with metronidazole toxicity. Metronidazole was discontinued, and her condition improved rapidly. She was discharged 14 days later. The lesions in her cerebellar dentate nucleus and inferior colliculus, suspected to be vasogenic edema, had disappeared 5 to 10 days later, whereas the lesion in the SCC, which gradually diminishing, could still be faintly detected 40 days later, which corresponded to our suspicion of cytotoxic edema.
authors: Department of Neurology, Brain Attack Center Ota Memorial Hospital.
authors: Shuichiro
authors: S
authors: Neshige
authors: Yuhei
authors: Y
authors: Kanaya
authors: Shinichi
authors: S
authors: Takeshima
authors: Takeshi
authors: T
authors: Yoshimoto
authors: Akio
authors: A
authors: Tanaka
authors: Masaru
authors: M
authors: Kuriyama
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001922:Brain Abscess / Q000628:therapy*; D001929:Brain Edema / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D002529:Cerebellar Nuclei / Q000473:pathology; D003337:Corpus Callosum / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007245:Inferior Colliculi / Q000473:pathology; D009682:Magnetic Resonance Spectroscopy; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole