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VOLUME 9 , ISSUE 1 ( January-April, 2022 ) > List of Articles


Metronidazole-induced Neurotoxicity: A Case Report

Anandi Damodaran, Devdutt Nayak, Faisal Khan, Saima Majid, Imad Hamad, Mohamed Ibrahim

Keywords : Cerebellar signs, Dentate nucleus hyperintensity, Metronidaole toxicity, Peripheral neuropathy

Citation Information : Damodaran A, Nayak D, Khan F, Majid S, Hamad I, Ibrahim M. Metronidazole-induced Neurotoxicity: A Case Report. Bengal Physician Journal 2022; 9 (1):19-21.

DOI: 10.5005/jp-journals-10070-7077

License: CC BY-NC 4.0

Published Online: 01-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Metronidazole (MTZ) is an antibiotic from nitroimidazole group, commonly used for various medical and surgical indications especially anaerobic bacterial infection. Though usually safe, it can result in serious toxicity with prolonged use. It can affect both central and peripheral nervous system. Neurotoxicity presents as features of encephalopathy, cerebellar ataxia, dysarthria, and symmetrical sensory-motor polyneuropathy. Here, we are presenting our patient with liver abscess who received MTZ for 6 weeks and developed neurological side effects with cerebellar ataxia and dysarthria accompanied by MRI features—hyperintense signals in dentate nucleus consistent with toxicity and also features of symmetrical sensory-motor polyneuropathy. Cerebellar symptoms reversed with stopping the medication—however, his peripheral neuropathy had a static course with minimal recovery.

  1. Sorensen CG, Karlsson WK, Amin FM, et al. Metronidazole-induced encephalopathy: a systematic review. J Neurol 2020;267(1):1–13. DOI: 10.1007/s00415-018-9147-6.
  2. Daneman N, Cheng Y, Gomes T, et al. Metronidazole-associated neurologic events: a nested case-control study. Clin Infect Dis 2021;72(12):2095–2100. DOI: 10.1093/cid/ciaa395.
  3. Frasca D, Dahyot-Fizeier C, Adier C, et al. Metronidazole and hydroxy metronidazole central nervous system distribution: Microdialysis assessment of brain extracellular fluid concentrations in patients with acute brain injury. Antimicrob Agents Chemother 2014;58(2): 1019–1023. DOI: 10.1128/AAC.01760-13.
  4. Li L, Tang X, Li W, et al. A case of methylprednisolone treatment for metronidazole-induced encephalopathy. BMC Neurol 2019;19(1):49. DOI: 10.1186/s12883-019-1278-6.
  5. Ahmed A, Loes DJ, Bressler EL. Reversible resonance imaging findings in metronidazole-induced encephalopathy. Neurology 1995;45:588–589. DOI: 10.1212/wnl.45.3.588.
  6. Chandak S, Agarwal A, Shukla A, et al. A case report of metronidazole induced neurotoxicity in liver abscess patient and the usefulness of MRI for itsdiagnosis. J Clin Diagnostic Res 2016;10(1):TD06–TD07. DOI: 10.7860/JCDR/2016/14900.7031.
  7. Hwang GH, Sim YJ, Jeong HJ, et al. Metronidazole induced encephalopathy with peripheral polyneuropathy in patient with spinal cord injury. Korean J Spine 2012;9(1):44–48. DOI: 10.14245/kjs.2012.9.1.44.
  8. Peng Q, You Q, Zhang J, et al. Isolated involvement of corpus callosum in metronidazole-induced encephalopathy with concomitant peripheral neuropathy. A case report. Medicine (Balimore) 2020;99(20):e20198. DOI: 10.1097/MD.00000000 00020198.
  9. Phyu H, Edmond MB, Kobayashi T, et al. Metronidazole-induced encephalopathy. ID Cases 2019;18:e00639. DOI: 10.1016/j.idcr.2019.e00639.
  10. Kim E, Na DG, Kim EY, et al. MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol 2007;28(9):1652–1658. DOI: 10.3174/ajnr.A0655.
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