Question of the Day – Thursday March 1, 2018

Question- What are the potential neurological side effects of long-term metronidazole therapy?

Answer- The cited reference discusses “reversible metronidazole induced CNS disturbances”. These “appear to be associated with specific MRI changes of increased signal intensity of the dentate nuclei bilaterally, most notably seen on FLAIR sequences.” The predominant symptom is ataxia but may include encephalopathy and/or peripheral neuropathy. (Graves TD et al. Reversible metronidazole-induced cerebellar toxicity in a multiple transplant recipient. 2009 J Neurol Sci 285:238-240)