A case of metronidazole-induced neurotoxicity

A 35-year-old woman presented with a short history of dysarthria, poor coordination and ataxic gait. She was being treated with a long course of intravenous metronidazole and meropenem for an aortic root infection after type A thoracic aortic dissection repair. Bilaterally symmetrical high FLAIR signal abnormality within the cerebellar dentate nuclei was demonstrated on MRI. The dentate nuclei are the largest of the major deep cerebellar nuclei and are involved in planning and control of voluntary movements.1 Signal abnormality within this region is a rare but well-documented feature of metronidazole-induced neurotoxicity in patients on prolonged therapy.2 Metronidazole is a commonly used drug worldwide and metronidazole-induced neurotoxicity should be in the list of differential diagnoses in patients on prolonged treatment with this drug who present with abnormal neurology and multifocal MRI signal abnormalities, especially in the cerebellar dentate nuclei, brain stem and/or corpus callosum. This patient’s treatment...

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