Fatima Ambreen, Khanduri Sachin, Sultana Sadaf, Siddiqui Saim A, Gupta Ashkrit, Pathak Vaibhav, Mulani Mohsin, Khan Salma, Bansal Tanya
Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND.
Cureus. 2022 Sep 14;14(9):e29145. doi: 10.7759/cureus.29145. eCollection 2022 Sep.
Purpose This study aims to describe the magnetic resonance imaging (MRI) of the brain of five patients diagnosed with metronidazole-induced encephalopathy (MIE). In addition, the aim of our study was to better define the topographic distribution of lesions in MIE. Methods We retrospectively evaluated MRI findings before and after drug cessation in five patients diagnosed with MIE at Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India. The main MRI signal changes and lesion locations were studied. Results Among the patients observed, the average age of the patients with MIE was 55 years (range: 30-70 years). Cerebellar dysfunction, mainly ataxia, and altered mental status were seen in the majority of cases. The most frequently involved sites were the dentate nucleus (cerebellum), brain stem, and corpus callosum (splenium). In diffusion-weighted imaging (DWI), most lesions did not show true restricted diffusion, except for a solitary corpus callosum lesion. Conclusion Although drug-related side effects are more common with long-term use of metronidazole, they may also occur with high doses for short durations. The dentate nucleus, the splenium in the corpus callosum, and the brain stem are the most affected structures. Apart from a solitary lesion of the corpus callosum, all identified lesions were reversible at follow-up MRI after discontinuation of metronidazole. The clinical presentation and characteristic MRI changes are highly specific and can be correlated to make a rapid and more accurate diagnosis of this potentially treatable condition. Prognosis is excellent if detected early.
目的 本研究旨在描述5例被诊断为甲硝唑诱导性脑病（MIE）患者的脑部磁共振成像（MRI）表现。此外，我们研究的目的是更好地明确MIE病变的部位分布。方法 我们回顾性评估了印度北方邦勒克瑙市Era勒克瑙医学院及医院诊断为MIE的5例患者停药前后的MRI表现。研究了主要的MRI信号变化和病变位置。结果 在观察的患者中，MIE患者的平均年龄为55岁（范围：30 - 70岁）。大多数病例出现小脑功能障碍，主要为共济失调，以及精神状态改变。最常受累的部位是齿状核（小脑）、脑干和胼胝体（压部）。在扩散加权成像（DWI）中，除了一个孤立的胼胝体病变外，大多数病变未显示真正的扩散受限。结论 虽然甲硝唑长期使用时药物相关副作用更常见，但高剂量短期使用也可能发生。齿状核、胼胝体压部和脑干是受影响最严重的结构。除了一个孤立的胼胝体病变外，所有确诊的病变在停用甲硝唑后的随访MRI中均可逆。临床表现和特征性MRI变化具有高度特异性，可相互关联以快速、更准确地诊断这种潜在可治疗的疾病。如果早期发现，预后良好。
