Metronidazole neurotoxicity.

Magnetic resonance imaging (MRI) abnormalities have been described with metronidazole overdosage; however, it is not clear why only few patients develop these abnormalities and also with serum levels in the therapeutic range.[2] MRI brain lesions are hyperintense on T2-weighted and FLAIR sequences with no mass effect. The lesions may show restricted diffusion and are non-enhancing on contrast administration. Characteristically, these lesions are mostly symmetric and bilateral involving cerebellar dentate nuclei, midbrain, dorsal pons (the vestibular nucleus, abducens nucleus, and superior olivary nucleus), splenium of the corpus callosum, and the dorsal medulla. Unusual sites are the inferior olivary nucleus and cerebellar white matter.[3-6] MR spectroscopy abnormalities have been postulated to a reversible mitochondrial dysfunction in susceptible patients.[7] Reversal of clinical as well as MRI abnormalities after cessation of drug intake is characteristic feature of metronidazole intoxication.

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[2]  B. Hakyemez,et al.  Reversible cerebellar toxicity during treatment with ornidazole: the first case report , 2010, Journal of Neurology, Neurosurgery & Psychiatry.

[3]  K. Chang,et al.  MR Imaging of Metronidazole-Induced Encephalopathy: Lesion Distribution and Diffusion-Weighted Imaging Findings , 2007, American Journal of Neuroradiology.

[4]  L. Nafe.  Diazepam as a treatment for metronidazole toxicosis in dogs: a retrospective study of 21 cases , 2004 .

[5]  H. Schmid,et al.  Metronidazol-Encephalopathie der Ratte , 1973, Acta Neuropathologica.

[6]  N. Campeau,et al.  MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity. , 2003, AJNR. American journal of neuroradiology.

[7]  M. Schapiro,et al.  Reversible MR imaging and MR spectroscopy abnormalities in association with metronidazole therapy. , 2002, Journal of computer assisted tomography.

[8]  E. Wijdicks,et al.  Reversible metronidazole-induced lesions of the cerebellar dentate nuclei. , 2002, The New England journal of medicine.

[9]  C. Seifert,et al.  Toxic Metronidazole-Induced MRI Changes , 2000, The Annals of pharmacotherapy.

[10]  D. Loes,et al.  Reversible Magnetic Resonance Imaging Findings in metronidazole-induced Encephalopathy , 1995, Neurology.

[11]  M. Poss,et al.  Central nervous system toxicosis associated with metronidazole treatment of dogs: five cases (1984-1987). , 1989, Journal of the American Veterinary Medical Association.

[12]  W. Bradley,et al.  Metronidazole neuropathy. , 1977, British medical journal.

[13]  G. Placidi,et al.  Distribution and metabolism of 14C-metronidazole in mice. , 1970, Archives internationales de pharmacodynamie et de therapie.