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- 저자 : ( Ved Prakesh Pandey ) (검색결과 1 건)
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( Vikas Asati ),( Girish Bhageshwar Ramteke ),( Ved Prakesh Pandey ),( Ajay Deep Bhatnagar ),( Atul Shende ),( Karuna Mujalda ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Metronidazole, a 5-nitroimidazole is widely used for treatment of anaerobic bacterial, protozoal infections, adverse reactions include nausea, dry-mouth, vomiting, diarrhoea. Neurologic toxicity is rare. We report a rare case of ataxia & cerebellar lesions following therapy with metronidazole, which resolved rapidly after discontinuation of drug. 50- year old male presented with fever, right-hypochondriac pain, diagnosed as multiple liver abscesses, managed initially by drainage-of abscess, intravenous ciprofioxacin, metronidazole for 7 days. He improved, was discharged on oral metronidazole800mg thrice-a-day for 7days. He did not return for followup, but continued medication for next 20 days when he presented with slurring of speech, in-coordination, progressive unsteadiness of gait, subsequent inability to walk. He was alert, oriented, speech dysarthric, horizontal nystagmus 2-3 beats on lateralgaze; no vertical nystagmus, heelto- shin, fi nger-to-nose tests abnormal, power normal. Tone decreased. Refi exes equal. Stance wide-based, felt unsteady, unable to walk without support, sensory normal. MRI Brain-abnormal T2 as well as fiAIR hyperintensities in Dentate nuclei, deep cerebellar parenchyma, splenium of corpus callosum. Serum Metronidazole levels were normal. After discontinuation of metronidazole, patient started regaining ambulatory function was able to walk with-support in 4 days, without-support in 10days. Follow-up MRI at 8 weeks was normal with resolution of hyperintensities of dentatenuclei, cerebellum. Discussion: Cerebellar toxicity is rare adverse-event in patients treated with metronidazole. While proposed mechanism was high cumulative dose in most patients (25-1080 grams), our patient inspite of taking about 75 grams had normal serum Metronidazole levels. Exact mechanism by which Metronidazole causes reversible cerebellar ataxia and Dentate nuclei changes is unclear. Cerebellar toxicity should be considered in any patient who presents with ataxia-dysarthria and is receiving prolonged therapy with metronidazole. MRI should be performed for defi nitive diagnosis and metronidazole withdrawn. Further studies are needed to defi ne the pathogenesis of this unusual event.
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