An 84-year-old woman who received 2-month oral metronidazole therapy (500 mg 3 times daily) for Clostridium difficile-associated diarrhea was hospitalized for falls. Clinical examination revealed moderate dysarthria and cerebellar ataxia. MRI performed at admission showed bilateral fluidattenuated inversion recovery (FLAIR) symmetric hyperintense lesions in cerebellar dentate nuclei, superior colliculi, and periaqueductal gray matter (figure). Biological investigations showed no vitamin B 1 , B 9 , or B 12 deficiency. Dysarthria and gait disturbance resolved within days after interruption of the metronidazole treatment. Metronidazoleinduced encephalopathy must be considered whenever a patient on metronidazole experiences a subacute cerebellar syndrome.

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