Chong-Oon Park

Metronidazole Induced Encephalopathy in a Patient with Brain Abscess

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.

Pneumocephalus in the absence of craniofacial skull base fracture.

W e report a rare case of intracerebral pneumocephalus. It was not accompanied by the typical craniofacial skull base fracture. A 77-year-old woman presented with pneumocephalus following a pedestrian traffic accident. Neurologic and physical examination revealed multiple extensive emphysemas, multiple rib fractures, and lung contusions, but no facial or skull bone fractures. Computed tomography (CT) and simple X-ray did not reveal a craniofacial skull base fracture, although both imaging methods showed an air shadow in the internal carotid artery (ICA) pathway. Pneumocephalus and pneumoventricle are defined as an intracranial gas collection, with several reports in the literature describing various portals of entry and clinical situations that favor the introduction of air to the skull. Our report presents the possibility that pneumoventricle and pneumocephalus can occur even in the absence of a bony skull fracture.