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International Journal of Advances In Case Reports

Volume 11, Issue 1, 2024
Mcmed International
International Journal of Advances In Case Reports
Issn
XXX-XXXX (Print), 2349 - 8005 (Online)
Frequency
bi-annual
Email
editorijacr@mcmed.us
Journal Home page
http://mcmed.us/about/ijacr
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Abstract
Title
METRONIDAZOLE-INDUCED REVERSIBLE CEREBELLAR ATAXIA AND DENTATE NUCLEUS LESIONS: A CASE REPORT
Author
1Chun-Yu Liang, 1Shang-Chang Ho, 2Wei-Liang Chen, 1,3Chieh-Sen Chuang
Email
83954@cch.org.tw
keyword
Cerebellar ataxia, Metronidazole.
Abstract
Cerebellar ataxia is an uncommon side effect of metronidazole. Here, we present a case of cerebellar ataxia and bilateral cerebellar dentate nucleus lesions following the long-term use of metronidazole; these symptoms and imaging findings resolved rapidly after discontinuing use of the drug. A 67 year-old man, who was admitted because of a brain abscess, intravenously received ceftriaxone (2 g) every 12 hours and metronidazole (500 mg) every 6 hours after admission. After 64 days of metronidazole treatment, severe dysarthria, ataxia, down-beat nystagmus in all directions, and distal paresthesia in 4 limbs developed. Brain magnetic resonance imaging (MRI) showed hyperintense lesions over bilateral cerebellar dentate nuclei on T2-weighted, fluid-attenuated inversion-recovery, diffusion-weighted, and apparent diffusion coefficient images, with mild T1 gadolinium contrast enhancement. The patient’s cerebellar symptoms completely resolved within 12 days after discontinuing the use of metronidazole. Follow-up MRI 27 days later revealed complete resolution of the aforementioned findings. However, the numbness and tingling sensation over the 4 distal limbs persisted at a 6-week follow-up consultation. Prolonged use of metronidazole can lead to reversible cerebellar ataxia and dentate nucleus lesions, from which total resolution can be expected upon drug discontinuation. When the symptoms of metronidazole toxicity develop, clinicians should discontinue using the drug immediately. Specific MRI findings are suitable tools that facilitate diagnosing metronidazole-induced central nervous system toxicity.
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