뇌농양 환자에서의 metronidazole 뇌병증 ; 증례보고

초록

PURPOSE : Metronidazole–induced encephalopathy (MIEP) is toxic encephalopathy associated with the use of metronidazole. We experienced a case of brain abscess who developed severe MIEP during treatment period. MATERIALS AND METHODS : A 52 years old man admitted for brain abscess which presented with dysphasia and right side weakness RESULTS : A 52 years old man admitted for brain abscess which presented with dysphasia and right side weakness. He had stereotatic drainage of brain abscess. He had been treated with ceftriaxone and metronidazole. At 20thday of metronidazole treatment, he complained of tinnitus, diplopia, dizziness, dysphagia and grade 2 left hemiparesis. The brain MRI was taken to rule out the progression of brain abscess or other condition, such as cerebral infarction. The diffusion weighted MRI showed increased signal intensities in the periventricular white matter of right trigone, splenium of corpus callosum and the dentate nuclei of the cerebellum. After stopping metronidazole, his neurological abnormalities began to improve and normalized by 6 weeks. On the following MRI, abnormal MRI lesions were disappeared. CONCLUSION : Although MIEP occurs in typical locations, it is not easy to differentiate from other conditions such as cerebral infarction, demyelinating diseases and metabolic diseases. Neurosurgeons should be aware that severe MIEP can occur during the use of metronidazole though it is not common.