Fifty days after the first medication of metronidazole, we observed dysarthria and weakness of both hands. We performed esophagogastroduodenoscopy to check for gastric ulcer, but observed only atrophic gastritis on a pyloric antrum.

However the tests revealed normal finding.įorty five days after the first treatment of metronidazole she developed mild nausea and vomiting with dizziness. We examined Tinnel and Phalen sign and proceeded to do an electrophysiological study in the upper extremities as well as a cervical spine MRI, checking for Carpal Tunnel Syndrome (CTS), syringomyelia, and other complications that might have risen in the patient with spinal cord injury. However laboratory findings from blood and urine samples did not show any specific abnormalities (Hb: 12.4 g/dL, Protein: 5.7 gm/dL, Albumin: 3.5 g/dl, GOT: 38 IU/L, GPT: 59 IU/L, Na: 142meq/L, K: 4.3meq/L, Ca: 9.4mg/dL, P: 4.9mg/dL). The patient denied other symptoms including neck pain and hand weakness. One month after the first administration of metronidazole, she complained of a mild tingling sensation on both forearms and all fingers as stocking glove type. T2-weighted image ( A) and T1-weighted image ( B) reveal bursting fractures in the T6 and T7 vertebral bodies. However, observing this patient carefully, we have noticed something that might serve as detection for MIE with PPN despite paraplegia. This was because the sure signs (ataxia, gait difficulty, tingling sensation in lower extremity and so on) of the drug's side effects were not present due to the paraplegia. Whether the encephalopathy and PPN was induced by metronidazole or some other factor in patient with spinal cord injury, diagnosis at first glance proved to be very difficult. MIE with PPN is a very rare occurrence let alone a MIE on a patient with spinal cord injury, which has not been previously documented. Recently, we encountered a case of metronidazole-induced encephalopathy (MIE) with peripheral polyneuropathy (PPN) in patient with spinal cord injury (SCI).

In some cases, high doses and/or prolong use may produce several neurologic side effects including peripheral neuropathy, cerebellopathy, encephalopathy and seizure 2, 3, 5, 7). The most common side effects of metronidazole include nausea, headaches and the metallic taste in the mouth.

Once in the system the drug is taken up by the target and metabolized into its active form, inhibiting its normal function. This drug is in its inactive state when administered to a patient, allowing selective targeting. Metronidazole is a commonly used antimicrobial agent used for the treatment of protozoal and bacterial infection.

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