{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T07:57:10Z","timestamp":1780991830700,"version":"3.54.1"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["21K07452"],"award-info":[{"award-number":["21K07452"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["22H02948"],"award-info":[{"award-number":["22H02948"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Sakurai Memorial Fund for Medical Research","award":["The Sakurai Memorial Fund for Medical Research"],"award-info":[{"award-number":["The Sakurai Memorial Fund for Medical Research"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>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\u2019s encephalopathy-like pathology, little is known about the histopathological features of MIE. Here we report the first autopsy case of irreversible MIE.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>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\u00a0g\/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\u2019s encephalopathy in the brain.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-022-03006-4","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T06:02:57Z","timestamp":1671084177000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Correlation of magnetic resonance images with neuropathology of irreversible metronidazole-induced encephalopathy: an autopsy case report"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9375-9590","authenticated-orcid":false,"given":"Yasuo","family":"Miki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Murasawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinobu","family":"Takayasu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiyasu","family":"Tsushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Kakeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Mizukami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Wakabayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"3006_CR1","unstructured":"Mandel GL, Bennet JE, Dolin R. Metronidazole. Principles and practice of infectious diseases (Seventh edition). Churchill Livingstone. pp. 419-26."},{"key":"3006_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00415-018-9147-6","volume":"267","author":"CG S\u00f8rensen","year":"2020","unstructured":"S\u00f8rensen CG, Karlsson WK, Amin FM, Lindelof M. Metronidazole-induced encephalopathy: a systemic review. J Neurol. 2020;267:1\u201313.","journal-title":"J Neurol"},{"key":"3006_CR3","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.3174\/ajnr.A0655","volume":"28","author":"E Kim","year":"2007","unstructured":"Kim E, Na DG, Kim JH, Son KR, Chang KH. MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol. 2007;28:1652\u20138.","journal-title":"AJNR Am J Neuroradiol"},{"key":"3006_CR4","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1136\/bmj.2.6087.610","volume":"2","author":"WG Bradley","year":"1977","unstructured":"Bradley WG, Karlsson IJ, Rassol CG. Metronidazole neuropathy. Br Med J. 1977;2:10\u20131.","journal-title":"Br Med J"},{"key":"3006_CR5","first-page":"271","volume":"37","author":"RC Urtasun","year":"1978","unstructured":"Urtasun RC, Chapman JD, Feldstein ML, Band RP, Rabin HR, Wilson AF, et al. Peripheral neuropathy related to misonidazole: incidence and pathology. Br J Cancer Suppl. 1978;37:271\u20135.","journal-title":"Br J Cancer Suppl"},{"key":"3006_CR6","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1007\/BF00686856","volume":"25","author":"PV Rogulja","year":"1973","unstructured":"Rogulja PV, Kovac W, Schmid H. Metronidazole encephalopathy in rats. Acta Neuropathol. 1973;25:36\u201345.","journal-title":"Acta Neuropathol"},{"key":"3006_CR7","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1177\/0960327119867755","volume":"39","author":"MH Hassan","year":"2020","unstructured":"Hassan MH, Awadalla EA, Ali RA, Fouad SS, Abdel-Kahaar E. Thiamine deficiency and oxidative stress induced by prolonged metronidazole therapy can explain its side effects of neurotoxicity and infertility in experimental animals: effect of grapefruit co-therapy. Hum Exp Toxicol. 2020;39:834\u201347.","journal-title":"Hum Exp Toxicol"},{"key":"3006_CR8","unstructured":"Love S, Budka H, Ironside JM, Perry A. Greenfield\u2019s Neuropathology (ninth edition). CRC press. pp. 590-2."}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-022-03006-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-022-03006-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-022-03006-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T06:04:20Z","timestamp":1671084260000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-022-03006-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,15]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["3006"],"URL":"https:\/\/doi.org\/10.1186\/s12883-022-03006-4","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,15]]},"assertion":[{"value":"21 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 December 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval is not required for this autopsy case report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s family members for publication of this case report. A copy of the written consent is available for review by the series of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"485"}}