MRI of metronidazole induced cerebellar ataxia

Simultaneous involvement of these three structures of the Gullain-Mollaret triangle has not been described. 1 2 Deafferentiation of inferior olivary nucleus due to lesions in the dentate nucleus or central tegmental tract can result in transynaptic inferior olivary nucleus degeneration. 3 However, acute onset of symptoms, striking lesions in inferior olivary nucleus at the onset of illness and rapid symptom improvement may suggest primary pathology of olivary nucleus rather than secondary trans-synaptic degeneration which is expected to evolve over a longer time. Generation of free radicals by metronidazole was proposed to mediate tissue damage. 4 Symmetrical lesions of structures of the Guillain-Mollaret triangle in a patient with acute or subacute ataxia should raise suspicions of metronidazole neurotoxicity.