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Metronidazole is a well-recognized neurotoxin associated with peripheral neuropathy as well as encephalopathy, cerebellar dysfunction and seizures. Particularly vulnerable neural substructures include the splenium of the corpus collosum, dentate nuclei, as well as the brainstem, with concomitant symptoms of confusion, dysarthria, ataxia and nystagmus. Typically, lesions are bilateral and symmetric. Diffusion weighted imaging restricted diffusion associated with decreased ADC map, as was observed in our patient, is rare, as are focal symptoms such as gaze deviation, aphasia and hemiplegia. In a recent review of the literature, 64 patients with metronidazole toxicity were identified and only 11 had subcortical white matter tract involvement. Most patients had cerebellar dysfunction (75%) and many had encephalopathy (33%) or seizures (13%).

甲硝唑是一种公认的神经毒素，与周围神经病、脑病、小脑功能障碍和癫痫有关。易受损的神经亚结构包括胼胝体压部、齿状核和脑干，并伴有意识模糊、构音障碍、共济失调和眼球震颤等症状。通常情况下，病变是双侧对称的。该患者的影像学改变（DWI高信号和相应的ADC图低信号）以及局灶性症状，如凝视偏差，失语症和偏瘫是罕见的，2008年一篇文献综述中，共纳入64名甲硝唑中毒性患者，只有11名患者皮质下白质束受累。大多数有小脑功能障碍(75%)，脑病(33%)或癫痫(13%)。

Consistent with prior case reports, this man’s symptoms and MRI changes resolved after discontinuation of metronidazole. While acute onset of hemispheric symptoms often suggests stroke or seizure, this patient demonstrates the importance of maintaining metabolic dysfunction (metronidazole toxicity) in the differential diagnosis.

与以前的病例报告一致，该患者的症状和MRI改变在停用甲硝唑后消失。急性发作的半球症状通常提示脑卒中或癫痫发作，该病例说明代谢功能障碍(甲硝唑中毒)在脑卒中鉴别诊断中的重要性。