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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0655

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MR Imaging of Metronidazole-Induced Encephalopathy: Lesion Distribution and Diffusion-Weighted Imaging Findings

E. Kim^a,b, D.G. Na^a, E.Y. Kim^c, J.H. Kim^d, K.R. Son^a and K.H. Chang^a

^a Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
^b Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
^c Department of Radiology, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea
^d Department of Radiology, Seoul Metropolitan Boramae Hospital, Seoul, Korea

View larger version (59K): [in this window] [in a new window]   Fig 1. A 54-year-old man (patient 4) with spontaneous bacterial peritonitis. A, Axial FLAIR (TR/TE/TI = 6000/120/2000 ms) images demonstrate bilateral symmetric hyperintense lesions in the dorsal medulla (black thick arrows), vestibular (black thin arrows), abducens (white arrows), and a focal tegmental lesion of the superior olivary nuclei (arrowheads) of the dorsal pons, dentate nuclei of the cerebellum, red nuclei and tegmentum of the midbrain, and the splenium of the corpus callosum. B, DWIs (TR/TE = 3396/60) show bright signal intensity at the peripheral part of the cerebellar dentate nuclei and central part of the splenium. The lesions of the low pons and tegmentum of the midbrain are slightly hyperintense, and the lesions of dorsal medulla and central part of dentate nuclei are isointense on DWI. C, ADC maps show a focal area of low ADC in the splenium of the corpus callosum (black arrow) and a high ADC area in most areas of the dentate nuclei (white arrows).

View larger version (62K): [in this window] [in a new window]   Fig 2. A 55-year-old man with ischemic colitis (patient 6). A, Axial T2-weighted (TR/ TE = 5000/110) images demonstrate bilateral symmetric hyperintense lesions in the dorsal medulla, vestibular, abducens, and focal tegmental lesions of the superior olivary nuclei of the dorsal pons, dentate nuclei of the cerebellum, the tectum of the midbrain, and the splenium of the corpus callosum. B, DWI (TR/TE = 4000/73) and ADC maps show mild hyperintensity and slightly high ADC of the dentate nuclei and obvious hyperintensity and very low ADC of the splenium of the corpus callosum. C, Follow-up MR images obtained 15 days after drug discontinuation. T2-weighted images show that the hyperintense lesions of the dentate nucleus and pons have disappeared, but a residual hyperintense lesion is seen in the splenium of corpus callosum. Note the near normalization of ADC and residual hyperintensity of the residual splenium lesion on DWI.

View larger version (34K): [in this window] [in a new window]   Fig 3. A 64-year-old man with an intra-abdominal abscess (patient 3). A, Axial FLAIR (TR/TE/TI = 10,000/122/2000) images show bilateral symmetric hyperintense lesions in the inferior olivary nuclei (arrows) and dorsal medulla, dorsal pons, cerebellar dentate nuclei, splenium and genu of corpus callosum, and subcortical white matter of both cerebral hemispheres. B, Follow-up FLAIR images obtained 17 days after drug discontinuation show complete reversal of all lesions.