Wernicke’s Encephalopathy and Peripheral Polyneuropathy Developed during Long Term Metronidazole Therapy in a Patient with a Brain Abscess- A Case Report -
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Metronidazole can induce serious neurologic problems including peripheral neuropathy, seizures, and encephalopathy. We examined a patient with acute Wernicke’s encephalopathy and peripheral polyneuropathy that had developed after prolonged metronidazole therapy without a history of chronic alcoholism or poor nutritional intake. The 68-year-old man had been hospitalized for a brain abscess and was treated for 10 weeks with metronidazole (2 grams per day). This patient, who showed symptoms of numbness and tingling in the legs, was referred for electromyography (EMG) and was diagnosed with peripheral polyneuropathy. A few days later, he developed sudden ataxia, dizziness, and diplopia. The neurologic examination revealed nystagmus and ophthalmoplegia, and the FLAIR brain MRI showed symmetrical high signal intensity lesions in the cerebellar dentate nucleus, midbrain, tegmentum around the periaqueductal gray matter, and tectum. After administering intravenous thiamine and stopping the metronidazole therapy, he recovered from the ophthalmoplegia and ataxia. Brain MR showed complete recovery within 3 weeks; however the EMG remained abnormal for a further 6 months, although the symptoms were almost completely resolved by this time.
Abstract
Metronidazole can induce serious neurologic problems including peripheral neuropathy, seizures, and encephalopathy. We examined a patient with acute Wernicke’s encephalopathy and peripheral polyneuropathy that had developed after prolonged metronidazole therapy without a history of chronic alcoholism or poor nutritional intake. The 68-year-old man had been hospitalized for a brain abscess and was treated for 10 weeks with metronidazole (2 grams per day). This patient, who showed symptoms of numbness and tingling in the legs, was referred for electromyography (EMG) and was diagnosed with peripheral polyneuropathy. A few days later, he developed sudden ataxia, dizziness, and diplopia. The neurologic examination revealed nystagmus and ophthalmoplegia, and the FLAIR brain MRI showed symmetrical high signal intensity lesions in the cerebellar dentate nucleus, midbrain, tegmentum around the periaqueductal gray matter, and tectum. After administering intravenous thiamine and stopping the metronidazole therapy, he recovered from the ophthalmoplegia and ataxia. Brain MR showed complete recovery within 3 weeks; however the EMG remained abnormal for a further 6 months, although the symptoms were almost completely resolved by this time.
참고문헌 (10)
- Zuccoli G, "Neuroimaging findings in acute wernicke’s encephalopathy: review of the literature", Am J Roentgenol, 192, pp.501~508 (2009)
- Amato AA, "Acquired neuropathies, In Electrodiagnostic medicine, 2nd ed", pp.1000~ (2002), Hanley & Belfus
- Dreger LM, "Intermittent-dose metronidazole-induced peripheral neuropathy", Ann Pharmacother, 32, pp.267~268 (1998)
- Learned-Coughlin S, "Peripheral neuropathy induced by metronidazole", Ann Pharmacother, 28, pp.536~ (1994)
- Graves TD, "Reversible metronidazole-induced cerebellar toxicity in a multiple transplant recipient", J Neurol Sci, 285, pp.238~240 (2009)
- Boyce EG, "Persistent metronidazole-induced peripheral neuropathy", Ann Pharmacother, 24, pp.19~21 (1990)
- 유 현, "거짓막대장염에 동반된 급성 베르니케 뇌병증의 확산강조 자기공명영상 소견: 증례보고 및 문헌고찰", 대한영상의학회지, 54(6), pp.453~458 (2006), 대한영상의학회
- Kim E, "MR imaging of metronidazole-induced encephalopathy: Lesion distribution and diffusion-weighted imaging findings", AMERICAN JOURNAL OF NEURORADIOLOGY, 28(9), pp.1652~1658 (2007)
- Zuccoli G, "MR imaging findings in 56 patients with wernicke encephalopathy: nonalcoholics may differ from alcoholics", Am J Neuroradiol, 30, pp.171~176 (2009)
- Alston TA, "Enzymatic conversion of the antibiotic metronidazole to an analog of thiamine", Arch Biochem Biophys, 257, pp.357~362 (1987)