Neurological Sciences

, Volume 36, Issue 9, pp 1737–1739 | Cite as

Metronidazole-induced central and peripheral nervous system toxicity

  • G. Cação
  • S. Fontes
  • M. Salgado
  • T. Rodrigues
  • Joana Damásio
Letter to the Editor


Metronidazole is a commonly prescribed antiprotozoal and antibacterial agent. Common adverse effects include nausea, headache and metallic taste [1]. There are reports of nervous system toxicity, with cerebellar syndrome and neuropathy most frequently described and encephalopathy and seizures less commonly [2].

We describe a woman who developed sequential peripheral and central nervous system (CNS) toxicity, after metronidazole treatment. We discuss the pathophysiology of metronidazole-induced neurotoxicity and review reported cases.

Case report

We report a 37 years old woman with Crohn’s disease who was submitted to small bowel resection. Afterwards she was started on vitamins (B12, folic acid) and prophylactic antibiotics (ciprofloxacin 400 mg/day, metronidazole 1500 mg/day). Three months later, she developed lower limbs numbness and paresthesia, which progressed to involve upper limbs in a few days. In 2 weeks slurred speech and marked gait instability appeared....


Metronidazole Neurotoxicity Peripheral neuropathy Cerebellar ataxia 


Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10072_2015_2260_MOESM1_ESM.mpg (16.8 mb)
On segment one, taken at the time of the first clinical assessment, we may observe finger to finger and heel to knee dysmetria. The patient presents an unstable, wide base gait, with severe difficulties on tandem walking. On segment two, three weeks after the first video was taken, the patient presents no limb dysmetria. She has a normal base gait and no difficulties on tandem walking (MPG 17192 kb)


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Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  • G. Cação
    • 1
  • S. Fontes
    • 1
  • M. Salgado
    • 2
  • T. Rodrigues
    • 3
  • Joana Damásio
    • 1
  1. 1.Neurology DepartmentCentro Hospitalar do PortoPortoPortugal
  2. 2.Gastroenterology DepartmentCentro Hospitalar do PortoPortoPortugal
  3. 3.Neuroradiology DepartmentCentro Hospitalar do PortoPortoPortugal

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