Metronidazole induced cerebellar ataxia

Abstract

Metronidazole is a widely used antimicrobial usually prescribed by many specialist doctors for a short duration of 10-15 days. Prolonged use of metronidazole is rare. The present case is of a patient who used the drug for 4 months and developed peripheral neuropathy, convulsions, and cerebellar ataxia. He was treated with diazepam and levetiracetam. The patient recovered completely following discontinuation of metronidazole.

The occurrence of metronidazole-induced encephalopathy in cancer patients: A hospital-based retrospective study

“…Mostly, a dose above 1 g/day for at least 30 days or total dosage of 50 g can result in cerebellar ataxia. [16] Our data revealed that the occurrence of MIE is 8.6% for those cancer patients who receive totally >30-g metronidazole. The prolong use with more cumulative doses of oral form metronidazole therapy revealed a greater opportunity to develop MIE.…”

MRI findings of metronidazole neurotoxicity in a pediatric patient with chronic diarrhea

“…A case of metronidazole-associated cerebellar ataxia was described by Hari et al in 2013 [ 6 ] in which a 31-year-old male with an amebic liver abscess developed gait instability after 4 months of metronidazole therapy. MRI findings included a strikingly similar appearance to the case presented here with symmetric nonenhancing punctate foci of increased T2 signal in the pons bilaterally, facial nuclei, and dentate nuclei [ 6 ].…”

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“…Metronidazole can cause cerebellar toxicity when used for a prolonged duration of treatment, typically over 6 weeks to several months [76,77]. Symptoms can include ataxia, paresthesias, slurred speech, hypotonia, seizures, and nystagmus [76,77].…”

“…Metronidazole can cause cerebellar toxicity when used for a prolonged duration of treatment, typically over 6 weeks to several months [76,77]. Symptoms can include ataxia, paresthesias, slurred speech, hypotonia, seizures, and nystagmus [76,77]. Brain MRI can show evidence of toxicity with hyperintensities on T2 and FLAIR in the dentate nuclei, nodularity in the cerebellar parenchyma on T2, or cerebellar edema with increased diffusion coefficients [76][77][78][79][80].…”