Metronidazole-induced encephalopathy: a systematic review

  • Caspar Godthaab SørensenEmail author
  • William Kristian Karlsson
  • Faisal Mohammad Amin
  • Mette Lindelof


Background and aims

Metronidazole, a commonly used antibiotic drug, can cause adverse effects in the central nervous system termed metronidazole-induced encephalopathy, leading to diagnostic challenges. The condition is rare and a detailed description of its phenotype is lacking. In this systematic review we investigated the clinical features of metronidazole-induced encephalopathy to promote recognition and elaborate the description.


We performed a systematic literature search using and hand searched the reference lists of included articles and other publications of interest. We included case series and single reports describing individual patients developing symptoms from the central nervous system in relation to metronidazole treatment. Data were extracted and analyzed descriptively.


We identified 779 publications of which 112 papers comprising 136 patients were included. Typical findings were dysarthria, gait instability, limb dyscoordination and altered mental status. Frequently, patients concomitantly presented with metronidazole-induced polyneuropathy. Liver disease was the most common pre-existing condition. MRI showed a characteristic pattern of reversible symmetrical hyperintense lesions on T2/FLAIR of the dentate nuclei in 90% of patients. Most patients improved significantly after discontinuation of metronidazole. Poor outcome was associated with severe comorbidity.


Metronidazole-induced encephalopathy should be considered in patients presenting with neurological symptoms in relation to newly initiated or prolonged metronidazole treatment. MRI changes are highly characteristic and specific. Patients with liver disease are at increased risk. Prognosis is good if recognized early.


Metronidazole Encephalopathy Dentate nuclei Ataxia Magnetic resonance imaging Toxicology 



Denotes patients for whom polyneuropathy presented before CNS symptoms


Remaining symptoms of polyneuropathy at follow-up


Corpus callosum


Central nervous system


Chronic obstructive pulmonary disease


Cerebral white matter


Disseminated intravascular coagulation


Diabetes mellitus


Dentate nuclei




Dorsal midbrain


Midbrain with involvement of the red nuclei


Medulla oblongata


Medulla oblongata with involvement of the inferior olivary nuclei


Not reported


Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflicts of interest.

Ethical standards

Patient data in this review have previously been published with consent in accordance with the ethical standards in the Declaration of Helsinki.

Informed Consent

Patient consent was obtained for the images shown in Fig. 4.

Supplementary material

415_2018_9147_MOESM1_ESM.xlsx (30 kb)
Results of the systematic literature search including clinical data on identified cases of metronidazole-induced encephalopathy (XLSX 29 KB)


  1. 1.
    Klein EY et al (2018) Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci USA 115(15):E3463–E3470CrossRefPubMedGoogle Scholar
  2. 2.
    Morgan DJ et al (2011) Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis 11(9):692–701CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bhattacharyya S et al (2016) Antibiotic-associated encephalopathy. Neurology 86(10):963–971CrossRefPubMedGoogle Scholar
  4. 4.
    Lofmark S, Edlund C, Nord CE (2010) Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis 50(Suppl 1):S16–S23CrossRefPubMedGoogle Scholar
  5. 5.
    Goolsby TA, Jakeman B, Gaynes RP (2018) Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents 51(3):319–325CrossRefPubMedGoogle Scholar
  6. 6.
    Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Agah E et al (2017) Metronidazole-induced neurotoxicity presenting with sudden bilateral hearing loss, encephalopathy, and cerebellar dysfunction. Eur J Clin Pharmacol 73(2):249–250CrossRefPubMedGoogle Scholar
  8. 8.
    Agarwal A et al (2016) Metronidazole-Induced Cerebellar Tox. Neurol Int 8(1):6365CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ahmed A, Loes DJ, Bressler EL (1995) Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy. Neurology 45(3 Pt 1):588–589CrossRefPubMedGoogle Scholar
  10. 10.
    AlDhaleei W, AlMarzooqi A, Gaber N (2018) Reversible metronidazole-induced neurotoxicity after 10 weeks of therapy. BMJ Case Rep. CrossRefPubMedGoogle Scholar
  11. 11.
    Alvarez RS et al (1983) Central nervous system toxicity related to prolonged metronidazole therapy. Am J Obstet Gynecol 145(5):640–641CrossRefPubMedGoogle Scholar
  12. 12.
    Arik N, Cengiz N, Bilge A (2001) Metronidazole-induced encephalopathy in a uremic patient: a case report. Nephron 89(1):108–109CrossRefPubMedGoogle Scholar
  13. 13.
    Bae EH et al (2016) Metronidazole-Induced Encephalopathy: a case report. J Nippon Med Sch 83(2):44–45CrossRefPubMedGoogle Scholar
  14. 14.
    Bahn Y et al (2010) Metronidazole induced encephalopathy in a patient with brain abscess. J Korean Neurosurg Soc 48(3):301–304CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bailes J et al (1983) Encephalopathy with metronidazole in a child. Am J Dis Child 137(3):290–291PubMedGoogle Scholar
  16. 16.
    Bates JE, Almast J, Augustine EF (2015) Neonatal dentate nucleus T2 hyperintensity after in utero metronidazole exposure. Neurology 85(11):1006CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Beloosesky Y et al (2000) Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure. Am J Med Sci 319(5):338–339CrossRefPubMedGoogle Scholar
  18. 18.
    Bonda C, Evans MS (2015) Metronidazole CNS toxicity. Acta Neurol Belg 115(4):709–710CrossRefPubMedGoogle Scholar
  19. 19.
    Bonkowsky JL, Sondrup C, Benedict SL (2007) Acute reversible cerebellar lesions associated with metronidazole therapy. Neurology 68(3):180CrossRefPubMedGoogle Scholar
  20. 20.
    Bottenberg MM et al (2011) Metronidazole-induced encephalopathy: a case report and review of the literature. J Clin Pharmacol 51(1):112–116CrossRefPubMedGoogle Scholar
  21. 21.
    Cacao G et al (2015) Metronidazole-induced central and peripheral nervous system toxicity. Neurol Sci 36(9):1737–1739CrossRefPubMedGoogle Scholar
  22. 22.
    Cantador AA et al (2013) Nonconvulsive status with metronidazole. Neurohospitalist 3(4):185–189CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cecil KM et al (2002) Reversible MR imaging and MR spectroscopy abnormalities in association with metronidazole therapy. J Comput Assist Tomogr 26(6):948–951CrossRefPubMedGoogle Scholar
  24. 24.
    Chacko J et al (2011) Clinical, neuroimaging and pathological features of 5-nitroimidazole-induced encephalo-neuropathy in two patients: Insights into possible pathogenesis. Neurol India 59(5):743–747CrossRefPubMedGoogle Scholar
  25. 25.
    Chakrabarti S, Pan K (2014) Metronidazole-induced encephalopathy: an uncommon scenario. N Z Med J 127(1393):120–122PubMedGoogle Scholar
  26. 26.
    Chandak S et al (2016) A case report of metronidazole induced neurotoxicity in liver abscess patient and the usefulness of MRI for its diagnosis. J Clin Diagn Res 10(1):TD06–T7PubMedPubMedCentralGoogle Scholar
  27. 27.
    Chatzkel JA, Vossough A (2010) Metronidazole-induced cerebellar toxicity. Pediatr Radiol 40(8):1453CrossRefPubMedGoogle Scholar
  28. 28.
    Chaudhari TS, Malhotra HS, Garg RK (2014) Face of the giant panda with bright eyes in metronidazole neurotoxicity. Neurol India 62(2):212–213CrossRefPubMedGoogle Scholar
  29. 29.
    Cheong HC et al (2011) Metronidazole-induced encephalopathy in a patient with liver cirrhosis. Korean J Hepatol 17(2):157–160CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Clements A (2017) Case report of metronidazole-induced encephalopathy. WMJ 116(5):221–223PubMedGoogle Scholar
  31. 31.
    De Bleecker JL, Leroy BP, Meire VI (2005) Reversible visual deficit and Corpus callosum lesions due to metronidazole toxicity. Eur Neurol 53(2):93–95CrossRefPubMedGoogle Scholar
  32. 32.
    Deenadayalu VP et al (2005) Abnormal enhancing lesion of dentate nuclei causing neurologic symptoms induced by metronidazole toxicity. Clin Gastroenterol Hepatol 3(3):xxixCrossRefPubMedGoogle Scholar
  33. 33.
    Demel SL, Jovin TG, Jadhav AP (2015) Metronidazole toxicity presenting with acute onset of aphasia and right sided weakness. J Clin Neurosci 22(7):1199–1200CrossRefPubMedGoogle Scholar
  34. 34.
    Desai JA et al (2011) Metronidazole-induced encephalopathy: case report and review of MRI findings. Can J Neurol Sci 38(3):512–513CrossRefPubMedGoogle Scholar
  35. 35.
    Dhar A et al (2016) Mystery case: metronidazole-induced encephalopathy. Neurology 87(9):e89–e90CrossRefPubMedGoogle Scholar
  36. 36.
    Erdener SE et al (2013) Brain MRI evolution of metronidazole intoxication. Neurology 80(19):1816–1817CrossRefPubMedGoogle Scholar
  37. 37.
    Eren F et al (2017) A case with reversible neurotoxicity induced by metronidazole. Ideggyogy Szem 70(11–12):429–432CrossRefGoogle Scholar
  38. 38.
    Etxeberria A et al (2012) Metronidazole-cerebellopathy associated with peripheral neuropathy, downbeat nystagmus, and bilateral ocular abduction deficit. Rev Neurol (Paris) 168(2):193–195CrossRefGoogle Scholar
  39. 39.
    Farmakiotis D, Zeluff B (2016) Images in clinical medicine. Metronidazole-associated encephalopathy. N Engl J Med 374(15):1465CrossRefGoogle Scholar
  40. 40.
    Foreid H et al. (2009) Reversible iatrogenic subacute cerebellar syndrome, myoclonus and MRI findings following metronidazole administration. BMJ Case RepGoogle Scholar
  41. 41.
    Frytak S, Moertel CH, Childs DS (1978) Neurologic toxicity associated with high-dose metronidazole therapy. Ann Intern Med 88(3):361–362CrossRefPubMedGoogle Scholar
  42. 42.
    Furukawa S et al (2015) Metronidazole-induced encephalopathy with contrast enhancing lesions on MRI. J Neurol Sci 352(1–2):129–131CrossRefPubMedGoogle Scholar
  43. 43.
    Galvez M, Brahm J, Miranda M (2009) Movement disorders as a manifestation of metronidazole-induced encephalopathy in a patient with chronic liver disease. Mov Disord 24(12):1864–1866CrossRefPubMedGoogle Scholar
  44. 44.
    Godfrey MS, Finn A, Zainah H, Dapaah-Afriyie K (2015) Metronidazole-induced encephalopathy after prolonged metronidazole course for treatment of C. difficile colitis. BMJ Case Rep. CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Graves TD et al (2009) Reversible metronidazole-induced cerebellar toxicity in a multiple transplant recipient. J Neurol Sci 285(1–2):238–240CrossRefPubMedGoogle Scholar
  46. 46.
    Groothoff MV et al (2010) Irreversible encephalopathy after treatment with high-dose intravenous metronidazole. Clin Ther 32(1):60–64CrossRefPubMedGoogle Scholar
  47. 47.
    Gupta AK et al (2003) Metrondazole-induced neurotoxicity. J Assoc Physicians India 51:617–618PubMedGoogle Scholar
  48. 48.
    Halloran TJ (1982) Convulsions associated with high cumulative doses of metronidazole. Drug Intell Clin Pharm 16(5):409CrossRefPubMedGoogle Scholar
  49. 49.
    Hammami N et al (2007) Reversible metronidazole-induced encephalopathy. J Neuroradiol 34(2):133–136CrossRefPubMedGoogle Scholar
  50. 50.
    Hanji Y et al (2017) Metronidazole-induced encephalopathy associated with treatment for liver abscesses. J Gen Fam Med 18(5):265–267CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Hari A, Srikanth BA, Lakshmi GS (2013) Metronidazole induced cerebellar ataxia. Indian J Pharmacol 45(3):295–297CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Haridas A et al (2015) Metronidazole-Induced Encephalopathy in Chronic Diarrhoea. J Assoc Physicians India 63(6):77–79PubMedPubMedCentralGoogle Scholar
  53. 53.
    Heaney CJ, Campeau NG, Lindell EP (2003) MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity. AJNR Am J Neuroradiol 24(8):1615–1617PubMedPubMedCentralGoogle Scholar
  54. 54.
    Higashi M et al (2013) Metronidazole-induced encephalopathy. Intern Med 52(7):843–844CrossRefPubMedGoogle Scholar
  55. 55.
    Hobbs K et al (2015) Metronidazole-induced encephalopathy: not always a reversible situation. Neurocrit Care 22(3):429–436CrossRefPubMedGoogle Scholar
  56. 56.
    Horlen CK, Seifert CF, Malouf CS (2000) Toxic metronidazole-induced MRI changes. Ann Pharmacother 34(11):1273–1275CrossRefPubMedGoogle Scholar
  57. 57.
    Huang YT, Chen LA, Cheng SJ (2012) Metronidazole-induced encephalopathy: case report and review literature. Acta Neurol Taiwan 21(2):74–78PubMedGoogle Scholar
  58. 58.
    Hwang GH et al (2012) Metronidazole induced encephalopathy with peripheral polyneuropathy in patient with spinal cord injury. Korean J Spine 9(1):44–48CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Iqbal A et al (2013) Clinical and imaging perspective and unanswered questions in a case of metronidazole induced encephalopathy. Ann Indian Acad Neurol 16(4):569–571CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Ito H et al (2004) Reversible cerebellar lesions induced by metronidazole therapy for helicobacter pylori. J Neuroimaging 14(4):369–371CrossRefPubMedGoogle Scholar
  61. 61.
    Iwadate D et al (2017) Thiamine deficiency in metronidazole-induced encephalopathy: a metabolic correlation? J Neurol Sci 379:324–326CrossRefPubMedGoogle Scholar
  62. 62.
    Jang HJ et al (2012) Atypical metronidazole-induced encephalopathy in anaerobic brain abscess. J Korean Neurosurg Soc 52(3):273–276CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Kafadar I et al (2013) A rare adverse effect of metronidazole: nervous system symptoms. Pediatr Emerg Care 29(6):751–752CrossRefPubMedGoogle Scholar
  64. 64.
    Kalia V, Vibhuti, Saggar K (2010) Case report: MRI of the brain in metronidazole toxicity. Indian J Radiol Imaging 20(3):195–197CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Khodakaram K, Barmano N (2011) Uncommon reaction to a common prescription. Lancet 378(9787):288CrossRefPubMedGoogle Scholar
  66. 66.
    Kim DW et al (2004) Metronidazole-induced encephalopathy. J Neurol Sci 224(1–2):107–111CrossRefPubMedGoogle Scholar
  67. 67.
    Kim E et al (2007) MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol 28(9):1652–1658CrossRefPubMedGoogle Scholar
  68. 68.
    Kim H et al (2011) Metronidazole-induced encephalopathy in a patient with infectious colitis: a case report. J Med Case Rep 5:63CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Kim J et al (2017) Metronidazole-induced encephalopathy in a patient with Crohn’s disease. Intest Res 15(1):124–129CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Kim SM et al (2011) Serially changing metronidazole-induced encephalopathy. Can J Neurol Sci 38(6):921–924CrossRefPubMedGoogle Scholar
  71. 71.
    Knorr JP et al (2012) Metronidazole-induced encephalopathy in a patient with end-stage liver disease. Case Reports Hepatol 2012:209258CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Kumari P et al (2016) Metronidazole induced neurotoxicity in a case of liver abscess. Int J Hepatobiliary Pancreat Dis 6:96–99Google Scholar
  73. 73.
    Kuriyama A (2017) Chestnut sign: metronidazole-induced encephalopathy. J Emerg Med 52(1):101–102CrossRefPubMedGoogle Scholar
  74. 74.
    Kuriyama A et al (2011) Metronidazole-induced central nervous system toxicity: a systematic review. Clin Neuropharmacol 34(6):241–247CrossRefPubMedGoogle Scholar
  75. 75.
    Kusumi RK et al (1980) Central nervous system toxicity associated with metronidazole therapy. Ann Intern Med 93(1):59–60CrossRefPubMedGoogle Scholar
  76. 76.
    Lawford R, Sorrell TC (1994) Amebic abscess of the spleen complicated by metronidazole-induced neurotoxicity: case report. Clin Infect Dis 19(2):346–348CrossRefPubMedGoogle Scholar
  77. 77.
    Lee HC, Kim YE, Ma HI (2017) Metronidazole-induced craniocervical myoclonus with reversible bilateral dentate nucleus lesions. J Mov Disord 10(1):67–68CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Lee JH et al (2008) Metronidazole-induced toxic encephalopathy in a hemodialysis patient: a case report. Korean J Nephrol 27(6):743–746Google Scholar
  79. 79.
    Lee SS et al (2009) Reversible inferior colliculus lesion in metronidazole-induced encephalopathy: magnetic resonance findings on diffusion-weighted and fluid attenuated inversion recovery imaging. J Comput Assist Tomogr 33(2):305–308CrossRefPubMedGoogle Scholar
  80. 80.
    Lefkowitz A, Shadowitz S (2018) Reversible cerebellar neurotoxicity induced by metronidazole. CMAJ 190(32):E961CrossRefPubMedGoogle Scholar
  81. 81.
    McCabe J, Neale J, Varghese A (2017) A case of metronidazole-induced neurotoxicity. Postgrad Med J 93(1105):712CrossRefPubMedGoogle Scholar
  82. 82.
    Mehndiratta MM, Pandey S, Nayak R (2013) Metronidazole encephalopathy. J Assoc Physicians India 61(7):485PubMedGoogle Scholar
  83. 83.
    Mittal GK et al (2017) Dentate hyperintensities—the imaging signature of metronidazole induced encephalopathy. J Neurosci Rural Pract 8(2):272–273CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Mizuta K et al (2018) Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report. BMC Musculoskelet Disord 19(1):336CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Moosa AN, Perkins D (2010) Neurological picture. MRI of metronidazole induced cerebellar ataxia. J Neurol Neurosurg Psychiatry 81(7):754–755CrossRefPubMedGoogle Scholar
  86. 86.
    Moriya M et al (2013) Reversible lesions of cerebellar dentate nuclei associated with metronidazole therapy. Neurol Clin Neurosci 1(6):227–228CrossRefGoogle Scholar
  87. 87.
    Mulcahy H, Chaddha SK (2008) MRI of metronidazole-induced encephalopathy. Radiol Case Rep 3(4):239CrossRefPubMedGoogle Scholar
  88. 88.
    Naqi R, Azeemuddin M, Beg MA (2012) Magnetic resonance imaging of metronidazole induced encephalopathy. J Pak Med Assoc 62(8):843–844PubMedGoogle Scholar
  89. 89.
    Ng PS, Saini M (2014) Reversible metronidazole-induced subacute cerebellar syndrome. QJM 107(12):1051–1052CrossRefPubMedGoogle Scholar
  90. 90.
    Onuma Y et al (2017) Irreversible metronidazole encephalopathy in an elderly woman with primary biliary cholangitis. J Gen Fam Med 18(6):436–438CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Papathanasiou A et al (2013) Metronidazole-induced reversible encephalopathy in a patient with facioscapulohumeral muscular dystrophy. Clin Neuroradiol 23(3):217–219CrossRefPubMedGoogle Scholar
  92. 92.
    Park KI, Chung JM, Kim JY (2011) Metronidazole neurotoxicity: sequential neuroaxis involvement. Neurol India 59(1):104–107CrossRefPubMedGoogle Scholar
  93. 93.
    Patel K et al (2008) Cerebellar ataxia following prolonged use of metronidazole: case report and literature review. Int J Infect Dis 12(6):e111–e114CrossRefPubMedGoogle Scholar
  94. 94.
    Rizvi I et al (2018) Metronidazole-associated encephalopathy: a reversible condition. Intern Emerg Med 13(8):1323–1325CrossRefPubMedGoogle Scholar
  95. 95.
    Roy U et al (2016) Clinical and neuroradiological spectrum of metronidazole induced encephalopathy: our experience and the review of literature. J Clin Diagn Res 10(6):OE01–O9PubMedPubMedCentralGoogle Scholar
  96. 96.
    Sandip S, Afshan I, Khandelwal RK (2015) MR features of metronidazole-induced encephalopathy. BMJ Case RepGoogle Scholar
  97. 97.
    Sarna JR, Brownell AK, Furtado S (2009) Cases: reversible cerebellar syndrome caused by metronidazole. CMAJ 181(9):611–613CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Senthilkumaran S et al (2015) Metronidazole encephalopathy: uncommon reaction to a common drug. Int J Crit Illn Inj Sci 5(2):123–124CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    Seok JI et al (2003) Metronidazole-induced encephalopathy and inferior olivary hypertrophy: lesion analysis with diffusion-weighted imaging and apparent diffusion coefficient maps. Arch Neurol 60(12):1796–1800CrossRefPubMedGoogle Scholar
  100. 100.
    Sevy A et al (2011) Central and peripheral neurotoxicity of metronidazole after treatment for brain abscess. Acta Neurochir (Wien) 153(12):2491–2492CrossRefGoogle Scholar
  101. 101.
    Simonetta F, Christou F, Vandoni RE, Nierle T (2013) Walking unsteadily: a case of acute cerebellar ataxia. BMJ Case Rep. CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Singh R et al (2017) Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy. Indian J Radiol Imaging 27(2):129–132CrossRefPubMedPubMedCentralGoogle Scholar
  103. 103.
    Sonthalia N et al (2016) Metronidazole-induced encephalopathy in alcoholic liver disease: a diagnostic and therapeutic challenge. J Emerg Med 51(4):e79–e83CrossRefPubMedGoogle Scholar
  104. 104.
    Sørensen CG et al. (2018) Convulsive seizures as presenting symptom of metronidazole-induced encephalopathy: a case report. Case Rep Neurol 10(1):34–37CrossRefPubMedPubMedCentralGoogle Scholar
  105. 105.
    Sudan YS et al (2016) Headphone sign: Metronidazole-induced encephalopathy. Neurol India 64(6):1374–1376CrossRefPubMedGoogle Scholar
  106. 106.
    Takada K et al (2018) Metronidazole Induced encephalopathy mimicking an acute ischemic stroke event. Neurol Med Chir (Tokyo) 58(9):400–403CrossRefGoogle Scholar
  107. 107.
    Tan CH et al (2011) Painful neuropathy due to skin denervation after metronidazole-induced neurotoxicity. J Neurol Neurosurg Psychiatry 82(4):462–465CrossRefPubMedGoogle Scholar
  108. 108.
    Taniyama D, Maruki T (2018) Metronidazole-associated encephalopathy. Am J Trop Med Hyg 98(2):351–352CrossRefPubMedPubMedCentralGoogle Scholar
  109. 109.
    Thakkar N et al (2016) Metronidazole Induced Encephalopathy. J Assoc Physicians India 64(11):72–74PubMedGoogle Scholar
  110. 110.
    Vitturi BK et al (2018) Metronidazole-induced encephalopathy. Rev Neurol (Paris) 174(5):342–343CrossRefGoogle Scholar
  111. 111.
    Vivas LL et al (2016) An 82-year-old man with ataxia and dysarthria. CMAJ 188(17–18):1251–1254CrossRefPubMedPubMedCentralGoogle Scholar
  112. 112.
    Ward F, Crowley P, Cotter PE (2015) Acute cerebellar syndrome associated with metronidazole. Pract Neurol 15(4):298–299CrossRefPubMedGoogle Scholar
  113. 113.
    Wienbren M et al (1985) Convulsions and encephalopathy in a patient with leukemia after treatment with metronidazole. J Clin Pathol 38(9):1076CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Woodruff BK, Wijdicks EF, Marshall WF (2002) Reversible metronidazole-induced lesions of the cerebellar dentate nuclei. N Engl J Med 346(1):68–69CrossRefPubMedGoogle Scholar
  115. 115.
    Yagi S, Matsumoto H, Hashida H (2018) Asymmetric magnetic resonance imaging findings in metronidazole-induced encephalopathy. Intern Med 57(13):1955–1956CrossRefPubMedPubMedCentralGoogle Scholar
  116. 116.
    Yagi T et al (2015) Metronidazole-induced encephalopathy and myoclonus: case report and a review of the literature. Neurol Clin Neurosci 3(3):111–113CrossRefGoogle Scholar
  117. 117.
    Yamamoto T et al (2012) Metronidazole-induced neurotoxicity developed in liver cirrhosis. J Clin Med Res 4(4):295–298PubMedPubMedCentralGoogle Scholar
  118. 118.
    Yui JC, Bonnes SL (2017) 74-Year-old woman with dysarthria and left lower extremity weakness. Mayo Clin Proc 92(6):973–977CrossRefPubMedGoogle Scholar
  119. 119.
    de Souza A, Narvencar KP, Sindhoora KV (2013) The neurological effects of methyl bromide intoxication. J Neurol Sci 335(1–2):36–41CrossRefPubMedGoogle Scholar
  120. 120.
    Gopinath KG et al (2015) Ornidazole-induced ataxia in an Indian woman: a case report. SAGE Open Med Case Rep 3:2050313 × 15621857Google Scholar
  121. 121.
    Taskapilioglu O et al (2010) Reversible cerebellar toxicity during treatment with ornidazole: the first case report. J Neurol Neurosurg Psychiatry 81(3):349–350CrossRefPubMedGoogle Scholar
  122. 122.
    Bond KM et al (2017) Dentate update: imaging features of entities that affect the dentate nucleus. AJNR Am J Neuroradiol 38(8):1467–1474CrossRefPubMedGoogle Scholar
  123. 123.
    Khadilkar S et al (2016) A practical approach to diseases affecting dentate nuclei. Clin Radiol 71(1):107–119CrossRefPubMedGoogle Scholar
  124. 124.
    Dainer MJ (1979) Untoward reaction to Flagyl (metronidazole). Am J Obstet Gynecol 133(8):939–940CrossRefPubMedGoogle Scholar
  125. 125.
    Davidson K, Clare AW (1989) Psychotic illness following termination of pregnancy. Br J Psychiatry 154:559–560CrossRefPubMedGoogle Scholar
  126. 126.
    Khandheria M, Snook E, Thomas C (2014) Psychotic episode secondary to metronidazole use. Gen Hosp Psychiatry 36(2):231 e3–e4CrossRefGoogle Scholar
  127. 127.
    Schreiber W, Spernal J (1997) Metronidazole-induced psychotic disorder. Am J Psychiatry 154(8):1170–1171PubMedGoogle Scholar
  128. 128.
    Uhl MD, Riely CA (1996) Metronidazole in treating portosystemic encephalopathy. Ann Intern Med 124(4):455CrossRefPubMedGoogle Scholar
  129. 129.
    Zahiruddin O, Shanooha M, Mohd MY, Azhar (2014) Psychosis induced by cefuroxime and metronidazole. Med J Malaysia 69(1):33–34PubMedGoogle Scholar
  130. 130.
    Lamp KC et al (1999) Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clin Pharmacokinet 36(5):353–373CrossRefPubMedGoogle Scholar
  131. 131.
    Nau R, Sorgel F, Eiffert H (2010) Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev 23(4):858–883CrossRefPubMedPubMedCentralGoogle Scholar
  132. 132.
    Cavanagh JB (1988) Lesion localisation: implications for the study of functional effects and mechanisms of action. Toxicology 49(1):131–136CrossRefPubMedGoogle Scholar
  133. 133.
    Rogulja Pv, Kovac W, Schmid H (1973) Metronidazol-encephalopathie der ratte. Acta Neuropathol 25(1):36–45CrossRefGoogle Scholar
  134. 134.
    Alston TA, Abeles RH (1987) Enzymatic conversion of the antibiotic metronidazole to an analog of thiamine. Arch Biochem Biophys 257(2):357–362CrossRefPubMedGoogle Scholar
  135. 135.
    Zuccoli G, Pipitone N (2009) Neuroimaging findings in acute Wernicke’s encephalopathy: review of the literature. AJR Am J Roentgenol 192(2):501–508CrossRefPubMedGoogle Scholar
  136. 136.
    Zuccoli G et al (2009) MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 30(1):171–176CrossRefPubMedGoogle Scholar
  137. 137.
    Evans J et al (2003) Diazepam as a treatment for metronidazole toxicosis in dogs: a retrospective study of 21 cases. J Vet Intern Med 17(3):304–310CrossRefPubMedGoogle Scholar
  138. 138.
    Bradley WG, Karlsson IJ, Rassol CG (1977) Metronidazole neuropathy. Br Med J 2(6087):610–611CrossRefPubMedPubMedCentralGoogle Scholar
  139. 139.
    Rao DN, Mason RP (1987) Generation of nitro radical anions of some 5-nitrofurans, 2- and 5-nitroimidazoles by norepinephrine, dopamine, and serotonin. A possible mechanism for neurotoxicity caused by nitroheterocyclic drugs. J Biol Chem 262(24):11731–11736PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologySjællands UniversitetshospitalRoskildeDenmark
  2. 2.Department of Clinical NeurophysiologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
  3. 3.Department of NeurologyRigshospitalet GlostrupCopenhagenDenmark
  4. 4.RoskildeDenmark

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