Importance of magnetic resonance imaging brain in metronidazole-induced cerebellar ataxia- a case report

Metronidazole is an antibiotic and an antiprotozoal drug, is cost effective treatment of choice in amoebic liver abscess. Cerebellar toxicity is quite rare and serious side effect of metronidazole, which is reversible. The importance of MRI brain in this condition is the typical finding of abnormal T2 as well as FLAIR hyperintensities in dentate nuclei and splenium of corpus callosum. We present a case of liver abscess on prolong metronidazole treatment presented with acute onset cerebellar ataxia.

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Neurological complications during treatment of liver abscess: think of metronidazole toxicity

Tropical Doctor ◽

10.1177/0049475520903651 ◽

2020 ◽

Vol 50 (2) ◽

pp. 165-166 ◽

Cited By ~ 1

Author(s):

Navneet Arora ◽

Kushal P Wasti ◽

Navida Babbar ◽

Atul Saroch ◽

Ashok K Pannu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Clinical Practice ◽

Magnetic Resonance ◽

Adverse Effects ◽

Liver Abscess ◽

Brain Magnetic Resonance Imaging ◽

Neurological Complications ◽

Amoebic Liver Abscess ◽

Resonance Imaging ◽

Dose Dependent

Related neurological adverse effects to metronidazole are rarely encountered in clinical practice despite its wide use as an antibacterial or antiparasitic agent. The neurotoxicity is not dose-dependent and is fully reversible with discontinuation of the drug. We describe a young man who was receiving metronidazole for an amoebic liver abscess and developed encephalopathy and seizures. Brain magnetic resonance imaging showed characteristic bilateral symmetrical cerebellar dentate hyperintensities.

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Lhermitte–Duclos Disease: Incidental Finding in Traumatic Cerebral Hemorrhage

Indian Journal of Neurotrauma ◽

10.1055/s-0041-1729136 ◽

2021 ◽

Author(s):

Hemant Kumar Beniwal ◽

Thatikonda Satish ◽

Gollapudi Prakash Rao ◽

Musali Siddartha Reddy ◽

Srikrishnaaditya Manne

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Intracranial Pressure ◽

Cerebellar Ataxia ◽

Cerebral Hemorrhage ◽

Incidental Finding ◽

Cowden Syndrome ◽

Young Female ◽

Resonance Imaging ◽

Increased Intracranial Pressure

AbstractLhermitte–Duclos disease, also known as dysplastic cerebellar gangliocytoma, is a rare hamartomatous tumor localized in cerebellum. An association with Cowden syndrome is observed in 50% of cases who present with symptoms of increased intracranial pressure and cerebellar ataxia. These patients have specific magnetic resonance imaging and histopathological findings. Surgical resection is the treatment of choice. Here, we report a case of a young female with traumatic frontal hemorrhage associated with Lhermitte–Duclos disease.

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Cost-effectiveness of Stockholm3 test and magnetic resonance imaging in prostate cancer screening: a microsimulation study

10.1101/2021.03.31.21254617 ◽

2021 ◽

Author(s):

Shuang Hao ◽

Emelie Heintz ◽

Ellinor Östensson ◽

Andrea Discacciati ◽

Fredrik Jäderling ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Cost Effectiveness ◽

Magnetic Resonance ◽

Cost Effective ◽

Resonance Imaging ◽

Life Years ◽

Incidence And Mortality ◽

Screening Strategies ◽

Reflex Threshold

AbstractObjectiveAssess the cost-effectiveness of no screening and quadrennial magnetic resonance imaging (MRI)-based screening for prostate cancer using either Stockholm3 or prostate-specific antigen (PSA) test as a reflex test.MethodsTest characteristics were estimated from the STHLM3-MR study (NCT03377881). A cost-utility analysis was conducted from a lifetime societal perspective using a microsimulation model for men aged 55-69 in Sweden for no screening and three quadrennial screening strategies, including: PSA≥3ng/mL; and Stockholm3 with reflex test thresholds of PSA≥1.5 and 2ng/mL. Men with a positive test had an MRI, and those MRI positive had combined targeted and systematic biopsies. Predictions included the number of tests, cancer incidence and mortality, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainties in key parameters were assessed using sensitivity analyses.ResultsCompared with no screening, the screening strategies were predicted to reduce prostate cancer deaths by 7-9% across a lifetime and were considered to be moderate costs per QALY gained in Sweden. Using Stockholm3 with a reflex threshold of PSA≥2ng/mL resulted in a 60% reduction in MRI compared with screening using PSA. This Stockholm3 strategy was cost-effective with a probability of 70% at a cost-effectiveness threshold of €47,218 (500,000 SEK).ConclusionsAll screening strategies were considered to be moderate costs per QALY gained compared with no screening. Screening with Stockholm3 test at a reflex threshold of PSA≥2ng/mL and MRI was predicted to be cost-effective in Sweden. Use of the Stockholm3 test may reduce screening-related harms and costs while maintaining the health benefits from early detection.

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A diagnostic decision tree for adult cerebellar ataxia based on pontine magnetic resonance imaging

Journal of the Neurological Sciences ◽

10.1016/j.jns.2018.02.022 ◽

2018 ◽

Vol 387 ◽

pp. 187-195 ◽

Cited By ~ 7

Author(s):

Miwa Higashi ◽

Kokoro Ozaki ◽

Takaaki Hattori ◽

Takashi Ishii ◽

Kazumasa Soga ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Decision Tree ◽

Cerebellar Ataxia ◽

Resonance Imaging ◽

Diagnostic Decision

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Association of Pediatric Acute-Onset Neuropsychiatric Syndrome With Microstructural Differences in Brain Regions Detected via Diffusion-Weighted Magnetic Resonance Imaging

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.4063 ◽

2020 ◽

Vol 3 (5) ◽

pp. e204063

Author(s):

Jimmy Zheng ◽

Jennifer Frankovich ◽

Emily S. McKenna ◽

Nathan C. Rowe ◽

Sarah J. MacEachern ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Regions ◽

Acute Onset ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging

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Magnetic resonance imaging brain findings in a case of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder, presenting with intractable vomiting and hiccups

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.193533 ◽

2017 ◽

Vol 08 (01) ◽

pp. 135-138 ◽

Cited By ~ 1

Author(s):

Prerna Garg ◽

Muthusubramanian Rajasekaran ◽

Salil Pandey ◽

Gnanashanmugam Gurusamy ◽

Devanand Balalakshmoji ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Neurological Disease ◽

Area Postrema ◽

Brain Lesions ◽

Neuromyelitis Optica Spectrum Disorder ◽

Resonance Imaging ◽

Immune Disease ◽

Mri Brain ◽

The Brain ◽

Aquaporin 4 Antibody

ABSTRACTNeuromyelitisoptica (NMO) and multiple sclerosis (MS) were once considered to be differing manifestation of same auto immune disease, NMO predominantly involving the optic nerve and cord. Now with discovery of NMO antibody the concept has changed and a spectrum of disorders with lesions in brain has been identified. Occasionally, brain may be the first or the only site of involvement in these disorders hence it is essential to be aware of this spectrum. The brain lesions in NMO/NMOSD may be located in characteristic regions and present with symptoms mimicking non neurological disease. We herein present a case of an adult female who was admitted with intractable vomiting and hiccups; subsequently on MRI brain found to have very tiny demyelinating foci in Area Postrema.

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The decision of targeted, systematic or combined biopsy in a biopsy naïve patient for the diagnosis of prostate cancer, can be made on the basis of multiparametric magnetic resonance imaging

Journal of Clinical Urology ◽

10.1177/2051415819889552 ◽

2019 ◽

Vol 13 (3) ◽

pp. 198-204

Author(s):

Debashis Sarkar ◽

Debashis Nandi ◽

Sameer Gangoli ◽

James Hicks ◽

Paul Carter

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Current Trend ◽

Specific Antigen ◽

Cost Effective ◽

Resonance Imaging ◽

Level Of Evidence ◽

Naive Patient ◽

Multiparametric Magnetic Resonance Imaging

Introduction: The current trend to implement multiparametric magnetic resonance imaging (mpMRI)-guided targeted biopsy (TB) as primary biopsy for the diagnosis of suspected prostate cancer and to avoid systematic biopsy (SB) is growing. However, concern remains regarding missing clinically significant (Cs) cancer on the normal mpMRI areas of the prostate. Therefore, we compared the normal and abnormal areas from mpMRI at the same prostate biopsy, using simultaneous SB and TB technique. Methods: A prospective, comparative effectiveness study included 134 patients initially referred for primary biopsy (from October 2017 to June 2018); 100 men were selected, mean age 68 years, with a median level of prostate specific antigen of 7.6, with average prostate volume of 52 cm3 (T3 disease and prostate imaging reporting and data system (PI-RADS) score < 3 were excluded). All underwent six cores TB (median), from an average of two lesions on mpMRI and also eight cores SB (median) from normal mpMRI areas of the prostate after informed consent. Results: The combined (SB + TB) biopsy cancer detection rate was 67%, 51% having Cs disease. For Cs cancer, 35 patients were detected by both techniques. TB missed four Cs cancer (95% confidence interval (CI), p < 0.0001). Fewer men in the TB group than in the SB group were found to have clinically insignificant (Ci) cancer (95% CI, p < 0.0001). No Cs cancer diagnosis was missed on TB from PI-RADS 5 lesion. Overall, 4% Cs cancers were missed on TB and avoided over diagnosis of 9% Ci cancer. Conclusions: Cognitive TB didn’t miss any Cs cancer from PI-RADS 5 lesion found on mpMRI. Only doing Cognitive TB on PI-RADS 5 lesion would save time, reduce workload and will be cost effective both for Urology and Pathology. PI-RADS 3 and 4 lesions on mpMRI will benefit from adding systematic samples. Level of evidence: 4 Oxford Centre for Evidence-Based Medicine (CEBM).

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