ArticleNeurocritical care2015
Metronidazole-induced encephalopathy: not always a reversible situation.
Article in Neurocritical care, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Metronidazole-induced encephalopathy: a systematic review.Journal of neurology · 2020Pooled it
- The Effect of Antibiotics on the Nervous System: Importance for Anesthesiology and Intensive Care.Antibiotics (Basel, Switzerland) · 2025Review
- Case Report: Metronidazole-induced encephalopathy in a patient with acute myeloid leukemia type 2 and a literature review of the pediatric case reports.Frontiers in pediatrics · 2025Article
- Frequency and Risk Factor Analysis for Metronidazole-Associated Neurologic Adverse Events.Journal of general internal medicine · 2024Article
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- MRI Findings and Topographic Distribution of Lesions in Metronidazole-Induced Encephalopathy.Cureus · 2022Article
- Antibiotics and the Nervous System-Which Face of Antibiotic Therapy Is Real, Dr. Jekyll (Neurotoxicity) or Mr. Hyde (Neuroprotection)?Molecules (Basel, Switzerland) · 2021Review
- Metronidazole, an Uncommon Cause of Dizziness and Ataxia in the Emergency Department: A Case Report.Clinical practice and cases in emergency medicine · 2021Article
- Metronidazole Encephalopathy EEG Features: A Case Report with Systematic Review of the Literature.Brain sciences · 2020Review
- Persistent dystonia and basal ganglia involvement following metronidazole induced encephalopathy.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2020Article
- Click chemistry-facilitated comprehensive identification of proteins adducted by antimicrobial 5-nitroimidazoles for discovery of alternative drug targets against giardiasis.PLoS neglected tropical diseases · 2020Article
- Metronidazole induced encephalopathy: case report and discussion on the differential diagnoses, in particular, Wernicke's encephalopathy.Journal of radiology case reports · 2019Article
- Neurological and Psychiatric Adverse Effects of Antimicrobials.CNS drugs · 2019Review
- Acute Encephalopathy Following Hyperbaric Oxygen Therapy in a Patient on Metronidazole.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2019Article
- A case of methylprednisolone treatment for metronidazole-induced encephalopathy.BMC neurology · 2019Article
- Metronidazole-induced Encephalopathy.IDCases · 2019Article
- Clinical efficacy of 12-h metronidazole dosing regimens in patients with anaerobic or mixed anaerobic infections.Therapeutic advances in infectious disease · 2018Article
- Irreversible metronidazole encephalopathy in an elderly woman with primary biliary cholangitis.Journal of general and family medicine · 2017Article
- An 82-year-old man with ataxia and dysarthria.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2016Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMetronidazole is a nitroimidazole antimicrobial drug prescribed to treat infections caused by anaerobic bacteria and protozoa. Uncommonly, it causes central nervous system (CNS) toxicity manifesting as metronidazole-induced encephalopathy (MIE).
methodsCase report.
resultsA 65-year-old woman with hepatitis B cirrhosis (Child-Pugh class C, MELD 21) developed progressive encephalopathy to GCS 4 during a 3-week course of metronidazole for cholecystitis. Initial MRI was consistent with CNS metronidazole toxicity, with symmetrical T2 hyperintensity and generally restricted diffusion in bilateral dentate nuclei, corpus callosum, midbrain, superior cerebellar peduncles, internal capsules, and cerebral white matter. Laboratory values did not demonstrate significant electrolyte shifts, and continuous EEG was without seizure. High-dose thiamine was empirically administered. Lumbar puncture was not performed due to coagulopathy and thrombocytopenia. Despite discontinuation of metronidazole and keeping ammonia levels near normal, the patient did not improve. MRI was repeated 1 week after discontinuation of metronidazole. Although there was decreased DWI hyperintensity in the dentate nuclei, diffuse T2 hyperintensity persisted and even progressed in the brainstem, basal ganglia, and subcortical white matter. Petechial hemorrhages developed in bilateral corticospinal tracts and subcortical white matter. T1 hypointensity appeared in the corpus callosum. She was transitioned to comfort measures only and died 12 days later.
conclusionMIE is an uncommon adverse effect of treatment with metronidazole that characteristically affects the dentate nuclei but may also involve the brainstem, corpus callosum, subcortical white matter, and basal ganglia. While the clinical symptoms and neuroimaging changes are usually reversible, persistent encephalopathy with poor outcome may occur.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.