Metronidazole Toxicity: A Case Series (P04.159)

Abstract

Objective: To describe four new cases of metronidazole toxicity. To correlate clinical findings with radiologic diagnoses of patients who presented with neurotoxicity as a direct result of their exposure to metronidazole. To review the characteristic MRI findings of metronidazole-induced neurotoxicity in order to aid in diagnosis of this potentially reversible condition. Background Metronidazole is a medication used frequently for treatment of infections caused by anaerobic bacteria and protozoa in multiple organ systems. With extended use, metronidazole can lead to neurotoxicity. There have been few reports in the literature demonstrating the classical MRI findings associated with metronidazole-induced cerebellar toxicity and the reversal of both clinical symptoms and imaging findings with cessation of the medication. Design/Methods: Retrospective case series. Results: We will review the pathophysiology of metronidazole-induced toxicity and present four novel cases of metronidazole-induced cerebellar toxicity with corresponding MR imaging. Conclusions: Patients with metronidazole-induced neurotoxicity present with bilateral cerebellar findings, correlating to abnormal signal in bilateral dentate nuclei. Bilateral dentate nuclei demonstrate hyperintensity on T2-weighted MR images, with increased DWI and ADC signal in metronidazole-induced neurotoxicity. In addition to resolution of clinical symptoms, the imaging findings reverse with cessation of metronidazole treatment. Correlation of clinical presentation with classic MRI findings can lead to more rapid and accurate diagnosis of this potentially reversible condition. Disclosure: Dr. Reaven has nothing to disclose. Dr. Reaven has nothing to disclose. Dr. Kouo has nothing to disclose. Dr. Shin has nothing to disclose.