Metronidazole-induced Simultaneous Peripheral Neuropathy and Encephalopathy in a Patient with Brain Abscess: A Case Report

, Hyoung Bae Jeon; , Cheol Su Jwa

Case Report

Journal of Korean Society of Geriatric Neurosurgery 2016;12(1):70-73.
Published online June 30, 2016.

Metronidazole-induced Simultaneous Peripheral Neuropathy and Encephalopathy in a Patient with Brain Abscess: A Case Report

Hyoung Bae Jeon , Cheol Su Jwa

Department of Neurosurgery, National Medical Center, Seoul, Korea

Abstract

A 53-year-old man presented with severe headache lasting several days. Initial magnetic resonance imaging (MRI) of the brain showed multiple ring-shaped enhanced cystic lesions surrounded by peripheral edema. Under suspicion of brain abscess, drainage of the lesion was performed. Subsequent intravenous metronidazole was used to control the anaerobic bacterium, Peptoniphilus asaccharolyticus. After eight weeks of metronidazole therapy, the patients suddenly developed headache, nausea, dizziness, slurred speech and paresthesia of the upper and lower limbs. Follow-up MRI of the brain revealed new bilateral signal intensities of the medulla and the middle cerebral peduncles. Electrophysiological study revealed severe sensorimotor polyneuropathy of the upper and lower extremities. Our final diagnosis was metronidazole-induced simultaneous peripheral neuropathy and encephalopathy. After stopping metronidazole, symptoms gradually improved. Relevant literature is discussed.

Key Words: Brain abscessㆍMetronidazoleㆍNeuropathy