Neshige Shuichiro, Kanaya Yuhei, Takeshima Shinichi, Yoshimoto Takeshi, Tanaka Akio, Kuriyama Masaru
Department of Neurology, Brain Attack Center Ota Memorial Hospital.
Rinsho Shinkeigaku. 2015;55(3):174-7. doi: 10.5692/clinicalneurol.55.174.
A 66-year-old woman was diagnosed with a brain abscess. The abscess was drained by sterotactic catheter insertion. She was administered metronidazole at a dose of 2 g/day. On the 30th day of treatment, she had nausea that gradually progressed. On the 45th day, she developed a disturbance of consciousness and was admitted to our department. She was in stuporous state, and had slight vestibular and cerebellar dysfunctions. Diffusion-weighted and FLAIR brain MR images showed bilateral symmetrical high signals in the splenium of the corpus callosum (SCC), cerebellar dentate nucleus, and inferior colliculus. The apparent diffusion coefficient (ADC) map was reduced in the SCC, but not in the other locations. The peak of lactate on MR spectroscopy was increased in the SCC. The clinical presentation and image changes of the patient were thought to be most consistent with metronidazole toxicity. Metronidazole was discontinued, and her condition improved rapidly. She was discharged 14 days later. The lesions in her cerebellar dentate nucleus and inferior colliculus, suspected to be vasogenic edema, had disappeared 5 to 10 days later, whereas the lesion in the SCC, which gradually diminishing, could still be faintly detected 40 days later, which corresponded to our suspicion of cytotoxic edema.
一名66岁女性被诊断为脑脓肿。通过立体定向导管插入术引流脓肿。给予她甲硝唑，剂量为2g/天。治疗第30天，她出现逐渐加重的恶心。第45天，她出现意识障碍并入住我科。她处于昏迷状态，有轻微的前庭和小脑功能障碍。弥散加权和液体衰减反转恢复序列脑磁共振成像显示胼胝体压部、小脑齿状核和下丘有双侧对称高信号。表观扩散系数图在胼胝体压部降低，但在其他部位未降低。磁共振波谱中乳酸峰在胼胝体压部升高。患者的临床表现和影像改变被认为最符合甲硝唑毒性。停用甲硝唑后，她的病情迅速改善。14天后出院。她小脑齿状核和下丘的病变，怀疑是血管源性水肿，在5至10天后消失，而胼胝体压部的病变逐渐缩小，40天后仍可隐约检测到，这与我们对细胞毒性水肿的怀疑相符。
