Metronidazole’s hidden impact: decoding cerebellar clues on MRI through a case report

A 70-year-old patient with a history of skull base osteomyelitis experienced slurred speech, dizziness, and coordination issues. He had been treated with both intravenous and oral metronidazole. Brain MRI revealed symmetrical areas of hyperintensity in the bilateral dentate nuclei, tectum, and splenium of the corpus callosum. These abnormalities nearly completely disappeared a few days after stopping the medication. Metronidazole, frequently used as an antiparasitic and antibacterial drug, can lead to neurotoxicity, particularly when used for extended periods. Symptoms generally improve after the drug is discontinued. MRI is vital for diagnosis and follow-up, as it detects specific changes in brain regions due to axonal swelling and increased water content.