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Roy U, Panwar A, Pandit A, et al. Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature. J Clin Diagn Res. 2016;10(6):OE01-9doi: 10.7860/JCDR/2016/19032.8054.
Roy, U., Panwar, A., Pandit, A., Das, S. K., & Joshi, B. (2016). Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature. Journal of clinical and diagnostic research : JCDR, 10(6), OE01-9. https://doi.org/10.7860/JCDR/2016/19032.8054
Roy, Ujjawal, et al. "Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature." Journal of clinical and diagnostic research : JCDR vol. 10,6 (2016): OE01-9. doi: https://doi.org/10.7860/JCDR/2016/19032.8054
Roy U, Panwar A, Pandit A, Das SK, Joshi B. Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature. J Clin Diagn Res. 2016 Jun;10(6):OE01-9. doi: 10.7860/JCDR/2016/19032.8054. Epub 2016 Jun 01. PMID: 27504340; PMCID: PMC4963700.
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J Clin Diagn Res. 2016 Jun;10(6):OE01-9. doi: 10.7860/JCDR/2016/19032.8054. Epub 2016 Jun 01.

Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature.

Journal of clinical and diagnostic research : JCDR

Ujjawal Roy, Ajay Panwar, Alak Pandit, Susanta Kumar Das, Bhushan Joshi

Affiliations

  1. Resident, Department of Neurology, Bangur Institute of Neurosciences, IPGMER , Kolkata, India .
  2. Senior Resident, Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital , New Delhi, India .
  3. Associate Professor, Department of Neurology, Bangur institute of Neurosciences, IPGMER , Kolkata, India .
  4. Resident, Department of Neurology, Bangur Institute of Neurosciences, IPGMER, Kolkata, India.

PMID: 27504340 PMCID: PMC4963700 DOI: 10.7860/JCDR/2016/19032.8054

Abstract

Metronidazole is an antimicrobial agent mainly used in the treatment of several protozoal and anaerobic infections, additionally, is often used in hepatic encephalopathy and Crohn disease. Apart from peripheral neuropathy, metronidazole can also cause symptoms of central nervous system dysfunction like ataxic gait, dysarthria, seizures, and encephalopathy which may result from both short term and chronic use of this drug and is collectively termed as "metronidazole induced encephalopathy"(MIE). Neuroimaging forms the backbone in clinching the diagnosis of this uncommon entity, especially in cases where there is high index of suspicion of intoxication. Although typical sites of involvement include cerebellum, brain stem and corpus callosum, however, lesions of other sites have also been reported. Once diagnosed, resolution of findings on Magnetic Resonance Imaging (MRI) of the Brain along with clinical improvement remains the mainstay of monitoring. Here we review the key clinical features and MRI findings of MIE as reported in medical literature. We also analyze implication of use of this drug in special situations like hepatic encephalopathy and brain abscess and discuss our experience regarding this entity.

Keywords: Cerebellum; Corpus callosum; Magnetic resonance imaging; Nitroimidazoles; Toxicity

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