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Case No. 091
0000-00-00~0000-00-00
출제자 : 관리자
Hit : 343
| Period | 0000-00-00~0000-00-00 |
|---|---|
| Diagnosis | |
| Clinical information | 40세 남자가 일주일 전부터 시작된 blurred speech와 3일전부터 시작된 ataxic gait로 내원. Liver transplantation후 발생한 liver abscess로 치료중 증상 발생. |
| Discussion | [정답] Metronidazole-induced cerebellar toxicity Large purulent abdominal abscess with fistula 8주동안 metronidazole 500mg t.i.d.로 치료함 (total dosage>75g) Progressive bilateral lower extremity weakness and dysarthria, severe ataxia 경과: 약을 중단한 후 5일만에 speech 정상으로 회복되고, 주위 도움없이 보행가능. 8주후 촬영한 MR상 normalize됨 <동물실험 결과> Metronidazole and its metabolite가 neuronal RNA에 부착하여 단백질 합성을 inhibition하여 axon의 degeneration을 일으킨다. Reversibility: demyelinating process의 가능성은 떨어짐. Axonal swelling with increased water content: T2 prolongation을 초래 High DW imaging signal intensity + increased ADC values: Vasogenic edema >>> ischemic process Conclusion) Increased T2 signal intensity in the deep cerebellar nuclei, associated increased ADC, and absence of mass effect and enhancement D/Dx : demyelinating disease metabolic infectious and inflammatory processes References) 1. Conor J. Heaneya, Norbert G. Campeaua and E. Paul Lindella . MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity. American Journal of Neuroradiology 2003; 24:1615-1617 2. Ahmed A, Loes DJ, Bressler EL. Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy. Neurology 1995 Mar; 45(3 Pt 1):588-9 |
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