Metronidazole is a commonly used antibiotic and patients with protracted clinical history may be administered high cumulative doses. Metronidazole induced encephalopathy is a rare but important sub-acute complication that has characteristic MRI features. Bilateral symmetrical T2-weighted hyperintense lesions are typically seen in cerebellar dentate nuclei, midbrain, dorsal pons, dorsal medulla, and splenium of corpus callosum. Early recognition of these imaging findings with prompt cessation of the medication improves prognosis and prevents irreversible neurological damage. The main differential consideration is Wernicke's encephalopathy, especially non-alcoholic Wernicke's encephalopathy with atypical findings.

From the manuscript

Metronidazole induced encephalopathy: case report and discussion on the differential diagnoses, in particular, Wernicke`s encephalopathy

Abstract
Metronidazole induced encephalopathy is a rare central nervous system toxicity, which may be completely reversible with prompt cessation of metronidazole usage. We present a case of metronidazole induced encephalopathy in a 59-year-old man with a history of Whipple`s procedure for pancreatic neuroendocrine tumour. The characteristic magnetic resonance imaging features of metronidazole induced encephalopathy and its main differential diagnosis, Wernicke`s encephalopathy, are discussed.