Metronidazole is commonly used for brain abscess but is not well known for its neurotoxic complications. Metronidazole-induced encephalopathy (MIEP) is toxic encephalopathy associated with the use of metronidazole. We experienced a case of brain abscess which developed reversible severe MIEP during treatment period. Although MIEP occurs in typical locations, it is not easy to differentiate from other conditions such as cerebral infarction, demyelinating diseases and metabolic diseases. Neurosurgeons should be aware that severe MIEP can occur during the use of metronidazole though it is not common.
Brain ; Brain Abscess ; Cerebral Infarction ; Demyelinating Diseases ; Humans ; Metabolic Diseases ; Metronidazole ; Neurotoxicity Syndromes

OBJECTIVE: This study aimed to evaluate the clinical course of subdural fluid (SDF) collection following surgery for a ruptured aneurysm and to set up a management plan for it. METHODS: Of 288 patients who underwent open aneurysm surgery for a ruptured aneurysm, 97 patients (33.7%) had impaired cerebrospinal fluid circulation in the form of subdural fluid collection or hydrocephalus during the postoperative period. We categorized these patients into 3 groups. Group A comprised patients who experienced spontaneously resolved postoperative SDF collection. Group B comprised patients who experienced a postoperative SDF collection that evolved into internal hydrocephalus. Group C comprised patients who experienced hydrocephalus without subdural fluid collection during the postoperative period. We retrospectively reviewed radiographic images and clinical data to determine the differences between the three groups with respect to age, initial clinical grade, and Fisher grade. RESULTS: Group B and group C had similar proportions of patients over 60 years of age in comparison to group A. Compared to group A, group B had a greater proportion of patients whose initial Hunt and Hess grades (HHG) were III, IV, or V (p = 0.040), and group B had a larger proportion of patients whose initial Fisher grades (FG) were III or IV (p = 0.020). CONCLUSION: Based on our understanding of SDF collection's clinical course and mechanism, we carefully suggest that clinicians consider the presence of cortical atrophy, the initial CT grade, and the clinical grades when establishing a treatment plan for SDF collection.
Aneurysm ; Aneurysm, Ruptured ; Atrophy ; Craniotomy ; Humans ; Hydrocephalus ; Postoperative Period ; Retrospective Studies ; Subarachnoid Hemorrhage ; Subdural Effusion