Metronidazole‐induced encephalopathy with transient cortical lesions

A 65‐year‐old woman developed metronidazole‐induced encephalopathy (MIE) with prolonged severe total aphasia during treatment for a liver abscess. Brain magnetic resonance imaging revealed restricted diffusion in the left cerebral white matter and splenium of the corpus callosum, along with transient cortical lesions but no typical dentate nucleus involvement. Despite discontinuing metronidazole, aphasia persisted for over a month, leading to her death. Although the white matter lesions persisted, the cortical lesions diminished after 2 weeks. This case highlights that MIE can involve the cerebral cortex, similar to Wernicke's encephalopathy.