[A case of metronidazole-induced encephalopathy that is difficult to differentiate from Wernicke encephalopathy].

Abstract

Herein, we present the case of a 76-year-old man diagnosed with an iliopsoas abscess 3 months prior and consequently administered metronidazole. The patient visited our facility complaining of difficulty in speaking and feeling unsteady when walking. Neurological findings showed dysarthria, nystagmus, and bilateral cerebellar ataxia. Head MRI-FLAIR demonstrated symmetrical hyperintensities in the bilateral cerebellar dentate nuclei, red nucleus, periaqueductal of the midbrain, periventricular third ventricle, and the corpus callosum. Although Wernicke's encephalopathy was among the differential diagnoses based on the imaging findings, the thiamine level was normal and improvement in symptoms and hyperintensity on FLAIR within 5 days of discontinuing metronidazole led to the diagnosis of metronidazole-induced encephalopathy. Although there were many similarities in the imaging findings of metronidazole-induced encephalopathy and Wernicke's encephalopathy, Metronidazole-induced encephalopathy should be initially considered when midbrain red nucleus lesions are observed.