Metronidazole
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Cerebellar syndrome: 2 case reports Two patients developed cerebellar syndrome during treatment with metronidazole. A 54-year-old man started receiving oral metronidazole [dosage not stated] for bronchiectasis. Two months later, he presented with an unsteady gait following a generalised tonic-clonic seizure, and a 3-day history of difficulty speaking. The estimated cumulative dose of metronidazole was about 60g. Bilateral cerebellar dysarthria and ataxia, and gait ataxia were observed on neurological examination. Over the next 4 days, his symptoms improved. One week later, his ataxia and dysarthria worsened, and he was hospitalised. MRI scan revealed bilateral symmetric hyperintensities in the dentate nuclei of his cerebellum. He had a second seizure after 1 month of admission, and phenytoin was started. He continued metronidazole for about 2 months after his initial presentation. At last followup, about 3 months after stopping metronidazole, his cerebellar syndrome had resolved; repeat MRI scan demonstrated complete resolution of his cerebellar lesions. A 72-year-old woman commenced metronidazole 500mg twice daily for an abdominal abscess. She developed cerebellar syndrome about 3 weeks later. Gait ataxia, and cerebellar dysarthria and ataxia were evident. Bilateral signal changes in her cerebellar dentate nuclei were observed on an MRI scan about 2 months later. Metronidazole toxicity was suspected, and metronidazole was withdrawn. Over the next few weeks, her symptoms gradually resolved. Complete resolution of her cerebellar dentate lesions was seen on a follow-up MRI scan 1 month after metronidazole withdrawal. Two months later, she died of unrelated causes. Author comment: "The MRI changes . . . resolved in both patients, thereby implicating [metronidazole] as the causative agent." Sarna JR, et al. Cases: Reversible cerebellar syndrome caused by metronidazole. CMAJ: Canadian Medical Association Journal 181: 611-3, No. 9, 27 Oct 2009 803005543 Canada
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Reactions 6 Feb 2010 No. 1287
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