Starrs Mary E, Yenigun Onur M
Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California.
Clin Pract Cases Emerg Med. 2021 May;5(2):239-241. doi: 10.5811/cpcem.2021.3.52046.
Metronidazole, a nitroimidazole antibiotic, is a well-known antibacterial and antiprotozoal agent that is generally well tolerated without many serious side effects. Most adverse reactions affect the gastrointestinal or genitourinary system, but the central nervous system may also be afflicted. In addition to headache and dizziness, cerebellar dysfunction can occur with metronidazole use.
We discuss the clinical presentation and imaging findings of metronidazole-induced encephalopathy in a 12-year-old male. The patient had a history of Crohn's disease and chronic Clostridium difficile infection for which he had received metronidazole for approximately 75 days prior to arrival to a local emergency department (ED). He presented with five days of progressive vertigo, nausea, vomiting, and ataxia. Subsequent magnetic resonance imaging showed symmetric hyperintense dentate nuclei lesions, characteristic of metronidazole-induced encephalopathy. The patient's symptoms improved rapidly after cessation of metronidazole, and his symptoms had completely resolved by discharge on hospital day two.
Metronidazole-induced encephalopathy is a rare cause of vertigo and ataxia that can lead to permanent sequela if not identified and treated promptly. Thus, it is important for physicians to keep this diagnosis in mind when evaluating patients on metronidazole who present to the ED with new neurologic complaints.
甲硝唑是一种硝基咪唑类抗生素，是一种广为人知的抗菌和抗原虫药物，通常耐受性良好，没有许多严重的副作用。大多数不良反应影响胃肠道或泌尿生殖系统，但中枢神经系统也可能受到影响。除头痛和头晕外，使用甲硝唑还可能发生小脑功能障碍。
我们讨论了一名12岁男性因甲硝唑诱发脑病的临床表现和影像学检查结果。该患者有克罗恩病和艰难梭菌慢性感染病史，在前往当地急诊科之前，他接受了约75天的甲硝唑治疗。他出现了五天的进行性眩晕、恶心、呕吐和共济失调。随后的磁共振成像显示齿状核对称高信号病变，这是甲硝唑诱发脑病的特征。停用甲硝唑后，患者症状迅速改善，到住院第二天出院时症状已完全消失。
甲硝唑诱发的脑病是眩晕和共济失调的罕见原因，如果不及时识别和治疗，可能导致永久性后遗症。因此，对于在急诊科就诊的、有新的神经系统症状且正在使用甲硝唑的患者，医生在评估时牢记这一诊断非常重要。
