{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T10:43:34Z","timestamp":1770461014417,"version":"3.49.0"},"reference-count":27,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,17]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>A woman in her 80s was admitted with a growing feeling of dizziness, tingling and vomiting that began a week before. The neurological examination showed dysarthria, downbeat nystagmus and gait ataxia. At the time, she was taking antibiotics (1 g amoxicillin and 500 mg metronidazole every 8 hours) following surgery for a mandibular abscess a month earlier.<\/jats:p>\n               <jats:p>Brain MRI showed T2 and FLAIR hyperintensities in dentate nuclei and splenium of the corpus callosum, findings described in metronidazole neurotoxicity. Metronidazole was discontinued, with resolution of all symptoms except lower limb paraesthesias.<\/jats:p>\n               <jats:p>Given the ageing population and the increasing use of pharmacological treatments for multiple conditions, drug-induced neurological complications are receiving growing attention, yet they often remain underrecognised. Metronidazole neurotoxicity is a rare adverse effect that should be considered especially during prolonged treatments. The most frequent debut resembles this case, with cerebellar dysfunction as the most common central nervous system toxicity and concomitant polyneuropathy frequently associated.<\/jats:p>","DOI":"10.1136\/bcr-2025-264904","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T14:25:18Z","timestamp":1750947918000},"page":"e264904","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Metronidazole-induced toxicity of the central and peripheral nervous system"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0719-3824","authenticated-orcid":false,"given":"Diego","family":"Villagr\u00e1n Sancho","sequence":"first","affiliation":[{"name":"Neurology, Hospital Universitario Virgen del Rocio, Seville, 81, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0094-249X","authenticated-orcid":false,"given":"Carlota","family":"Villar Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Neurology, Hospital Universitario Virgen del Rocio, Seville, 81, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0689-049X","authenticated-orcid":false,"given":"Antonio Crist\u00f3bal","family":"Luque Ambrosiani","sequence":"additional","affiliation":[{"name":"Neurology, Hospital Universitario Virgen del Rocio, Seville, 81, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0862-3192","authenticated-orcid":false,"given":"Pablo","family":"Baena-Palomino","sequence":"additional","affiliation":[{"name":"Neurology, Hospital Universitario Virgen del Rocio, Seville, 81, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"2025082709520375000_18.6.e264904.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-9147-6"},{"key":"2025082709520375000_18.6.e264904.2","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.ijantimicag.2017.08.033","article-title":"Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature","volume":"51","author":"Goolsby","year":"2018","journal-title":"Int J Antimicrob Agents"},{"key":"2025082709520375000_18.6.e264904.3","doi-asserted-by":"crossref","unstructured":"Herskovitz S , Schaumburg HH . Neuropathy associated with industrial agents, metals and drugs: pharmaceutical agents. In: Dyck PJ , Thomas PK , eds. Peripheral neuropathy. Philadelphia: Elsevier, 2005: 2553\u201383.","DOI":"10.1016\/B978-0-7216-9491-7.50117-4"},{"key":"2025082709520375000_18.6.e264904.4","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24951"},{"key":"2025082709520375000_18.6.e264904.5","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00007-10"},{"key":"2025082709520375000_18.6.e264904.6","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1212\/01.WNL.0000156835.12492.30","article-title":"Methyl bromide intoxication causes reversible symmetric brainstem and cerebellar MRI lesions","volume":"64","author":"Geyer","year":"2005","journal-title":"Neurology (ECronicon)"},{"key":"2025082709520375000_18.6.e264904.7","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.11622\/smedj.2013188","article-title":"Isoniazid-induced cerebellitis: a disguised presentation","volume":"55","author":"Peter","year":"2014","journal-title":"Singapore Med J"},{"key":"2025082709520375000_18.6.e264904.8","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199936050-00004"},{"key":"2025082709520375000_18.6.e264904.9","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1093\/cid\/ciaa395","article-title":"Metronidazole-associated Neurologic Events: A Nested Case-control Study","volume":"72","author":"Daneman","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2025082709520375000_18.6.e264904.10","doi-asserted-by":"crossref","first-page":"27","DOI":"10.33588\/rn.6901.2018501","article-title":"Encefalopat\u00eda inducida por metronidazol: descripci\u00f3n de un caso con hallazgos radiol\u00f3gicos y anatomopatol\u00f3gicos","volume":"69","author":"Gonz\u00e1lez Nafr\u00eda","year":"2019","journal-title":"RevNeurol"},{"key":"2025082709520375000_18.6.e264904.11","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0b013e3182334b35"},{"key":"2025082709520375000_18.6.e264904.12","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.08.1176"},{"key":"2025082709520375000_18.6.e264904.13","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.88a.21007"},{"key":"2025082709520375000_18.6.e264904.14","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2019190016"},{"key":"2025082709520375000_18.6.e264904.15","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.3174\/ajnr.A0655","article-title":"MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings","volume":"28","author":"Kim","year":"2007","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025082709520375000_18.6.e264904.16","doi-asserted-by":"publisher","DOI":"10.1016\/0003-9861(87)90577-7"},{"key":"2025082709520375000_18.6.e264904.17","doi-asserted-by":"publisher","DOI":"10.1892\/0891-6640(2003)017<0304:DAATFM>2.3.CO;2"},{"key":"2025082709520375000_18.6.e264904.18","doi-asserted-by":"publisher","DOI":"10.1159\/000046052"},{"key":"2025082709520375000_18.6.e264904.19","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s13760-015-0485-1","article-title":"Metronidazole CNS toxicity","volume":"115","author":"Bonda","year":"2015","journal-title":"Acta Neurol Belg"},{"key":"2025082709520375000_18.6.e264904.20","doi-asserted-by":"crossref","first-page":"104","DOI":"10.4103\/0028-3886.76882","article-title":"Metronidazole neurotoxicity: sequential neuroaxis involvement","volume":"59","author":"Park","year":"2011","journal-title":"Neurol India"},{"key":"2025082709520375000_18.6.e264904.21","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1212\/WNL.45.3.588","article-title":"Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy","volume":"45","author":"Ahmed","year":"1995","journal-title":"Neurology (ECronicon)"},{"key":"2025082709520375000_18.6.e264904.22","first-page":"1615","article-title":"MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity","volume":"24","author":"Heaney","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025082709520375000_18.6.e264904.23","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.12.1796"},{"key":"2025082709520375000_18.6.e264904.24","first-page":"386","article-title":"MRI and SPECT findings in a case of metronidazole-induced reversible acute cerebellar ataxia","volume":"45","author":"Takase","year":"2005","journal-title":"Rinsho Shinkeigaku"},{"key":"2025082709520375000_18.6.e264904.25","doi-asserted-by":"crossref","first-page":"44","DOI":"10.14245\/kjs.2012.9.1.44","article-title":"Metronidazole induced encephalopathy with peripheral polyneuropathy in patient with spinal cord injury","volume":"9","author":"Hwang","year":"2012","journal-title":"Korean J Spine"},{"key":"2025082709520375000_18.6.e264904.26","doi-asserted-by":"crossref","first-page":"743","DOI":"10.4103\/0028-3886.86552","article-title":"Clinical, neuroimaging and pathological features of 5-nitroimidazole-induced encephalo-neuropathy in two patients: Insights into possible pathogenesis","volume":"59","author":"Chacko","year":"2011","journal-title":"Neurol India"},{"key":"2025082709520375000_18.6.e264904.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12883-019-1278-6","article-title":"A case of methylprednisolone treatment for metronidazole-induced encephalopathy","volume":"19","author":"Li","year":"2019","journal-title":"BMC Neurol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-264904","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:52:09Z","timestamp":1756313529000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-264904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,26]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2025-264904"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-264904","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}