title: Metronidazole toxicity presenting with acute onset of aphasia and right sided weakness.
abstract: We report a 37-year-old man with a history of cirrhosis and methicillin-sensitive staphylococcus aureus (MSSA) bacteremia who presented from a nursing home with 1 week of progressive confusion followed by acute onset of aphasia, forced left eye deviation and right sided weakness. While clinical presentation was concerning for a left middle cerebral artery stroke, MRI was consistent with leukoencephalopathy. The man had been on metronidazole for 2 months for treatment of Clostridium difficile infection. This case exemplifies a stroke mimic to be considered when a patient presents with an acute focal neurological deficit.
authors: Department of Neurology, University of Pittsburgh Medical Center, Kaufmann Medical Building Suite 811, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
authors: Stacie L
authors: SL
authors: Demel
authors: Department of Neurology, University of Pittsburgh Medical Center, Kaufmann Medical Building Suite 811, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
authors: Tudor G
authors: TG
authors: Jovin
authors: Department of Neurology, University of Pittsburgh Medical Center, Kaufmann Medical Building Suite 811, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address: jadhavap@upmc.edu.
authors: Ashutosh P
authors: AP
authors: Jadhav
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001037:Aphasia / Q000139:chemically induced*; D016470:Bacteremia / Q000188:drug therapy; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy; D006801:Humans; D056784:Leukoencephalopathies / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008795:Metronidazole / Q000009:adverse effects* / Q000627:therapeutic use; D018908:Muscle Weakness / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole
keywords: Flagyl; Hemiparesis; Leukoencephalopathy; Stroke mimic