Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report
Abstract Background Neurological symptoms and radiographic abnormalities may remain in a small proportion of patients with metronidazole-induced encephalopathy (MIE). Although experimental animal models of MIE have suggested a Wernicke’s encephalopathy-like pathology, little is known about the histo...
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| Format: | Article |
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BMC
2022-12-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-022-03006-4 |
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| author | Yasuo Miki Yuki Takeuchi Shingo Murasawa Shinobu Takayasu Fumiyasu Tsushima Shingo Kakeda Hiroki Mizukami Koichi Wakabayashi |
| author_facet | Yasuo Miki Yuki Takeuchi Shingo Murasawa Shinobu Takayasu Fumiyasu Tsushima Shingo Kakeda Hiroki Mizukami Koichi Wakabayashi |
| author_sort | Yasuo Miki |
| collection | DOAJ |
| description | Abstract Background Neurological symptoms and radiographic abnormalities may remain in a small proportion of patients with metronidazole-induced encephalopathy (MIE). Although experimental animal models of MIE have suggested a Wernicke’s encephalopathy-like pathology, little is known about the histopathological features of MIE. Here we report the first autopsy case of irreversible MIE. Case presentation A 72-year-old Japanese woman with pancreatic neuroendocrine tumour and metastatic tumours in the liver developed intraabdominal bleeding from a hepatic abscess. She was administered metronidazole for 79 days (1.5 g/day), which caused dysarthria followed by hand tremor and altered mental status. Brain magnetic resonance imaging at the time of onset revealed hyperintensities in the deep white matter of the bilateral parietal lobes and splenium of the corpus callosum on diffusion-weighted imaging (DWI) with reduced apparent diffusion coefficient (ADC) values. Despite the improvement of dysarthria and hand tremor, her cognition remained affected even after the withdrawal of metronidazole. She died of pancreatic neuroendocrine tumour at the age of 74 years. Histopathological examinations of the brain confirmed a combination of severe demyelination and moderate axonal degeneration, which corresponded to the regions showing abnormal signal intensities on DWI with reduced ADC values. There were no pathological findings suggestive of Wernicke’s encephalopathy in the brain. Conclusion We have demonstrated the clinical, radiographic and histopathological aspects of irreversible MIE. Hyperintensities on DWI with reduced ADC values in affected regions may indicate a poor clinical prognosis due to irreversible pathological damage. |
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| id | doaj.art-c5bab90961ca4ad1b18b2bdae405c42c |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-13T04:28:56Z |
| publishDate | 2022-12-01 |
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| spelling | doaj.art-c5bab90961ca4ad1b18b2bdae405c42c2022-12-22T03:02:23ZengBMCBMC Neurology1471-23772022-12-012211510.1186/s12883-022-03006-4Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case reportYasuo Miki0Yuki Takeuchi1Shingo Murasawa2Shinobu Takayasu3Fumiyasu Tsushima4Shingo Kakeda5Hiroki Mizukami6Koichi Wakabayashi7Department of Neuropathology, Hirosaki University Graduate School of MedicineDepartment of Pathology and Molecular Medicine, Hirosaki University Graduate School of MedicineDepartment of Endocrinology and Metabolism, Hirosaki University Graduate School of MedicineDepartment of Endocrinology and Metabolism, Hirosaki University Graduate School of MedicineDepartment of Radiology, Hirosaki University Graduate School of MedicineDepartment of Radiology, Hirosaki University Graduate School of MedicineDepartment of Pathology and Molecular Medicine, Hirosaki University Graduate School of MedicineDepartment of Neuropathology, Hirosaki University Graduate School of MedicineAbstract Background Neurological symptoms and radiographic abnormalities may remain in a small proportion of patients with metronidazole-induced encephalopathy (MIE). Although experimental animal models of MIE have suggested a Wernicke’s encephalopathy-like pathology, little is known about the histopathological features of MIE. Here we report the first autopsy case of irreversible MIE. Case presentation A 72-year-old Japanese woman with pancreatic neuroendocrine tumour and metastatic tumours in the liver developed intraabdominal bleeding from a hepatic abscess. She was administered metronidazole for 79 days (1.5 g/day), which caused dysarthria followed by hand tremor and altered mental status. Brain magnetic resonance imaging at the time of onset revealed hyperintensities in the deep white matter of the bilateral parietal lobes and splenium of the corpus callosum on diffusion-weighted imaging (DWI) with reduced apparent diffusion coefficient (ADC) values. Despite the improvement of dysarthria and hand tremor, her cognition remained affected even after the withdrawal of metronidazole. She died of pancreatic neuroendocrine tumour at the age of 74 years. Histopathological examinations of the brain confirmed a combination of severe demyelination and moderate axonal degeneration, which corresponded to the regions showing abnormal signal intensities on DWI with reduced ADC values. There were no pathological findings suggestive of Wernicke’s encephalopathy in the brain. Conclusion We have demonstrated the clinical, radiographic and histopathological aspects of irreversible MIE. Hyperintensities on DWI with reduced ADC values in affected regions may indicate a poor clinical prognosis due to irreversible pathological damage.https://doi.org/10.1186/s12883-022-03006-4Metronidazole-induced encephalopathyMagnetic resonance imagingDiffusion-weighted imagingApparent diffusion coefficientCase report |
| spellingShingle | Yasuo Miki Yuki Takeuchi Shingo Murasawa Shinobu Takayasu Fumiyasu Tsushima Shingo Kakeda Hiroki Mizukami Koichi Wakabayashi Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report BMC Neurology Metronidazole-induced encephalopathy Magnetic resonance imaging Diffusion-weighted imaging Apparent diffusion coefficient Case report |
| title | Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report |
| title_full | Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report |
| title_fullStr | Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report |
| title_full_unstemmed | Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report |
| title_short | Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report |
| title_sort | correlation of magnetic resonance images with neuropathology of irreversible metronidazole induced encephalopathy an autopsy case report |
| topic | Metronidazole-induced encephalopathy Magnetic resonance imaging Diffusion-weighted imaging Apparent diffusion coefficient Case report |
| url | https://doi.org/10.1186/s12883-022-03006-4 |
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