BMJ Case Reports 2013; doi:10.1136/bcr-2012-007688
  • Unexpected outcome (positive or negative) including adverse drug reactions

Walking unsteadily: a case of acute cerebellar ataxia

  1. Thomas Nierle1
  1. 1Department of Internal Medicine, Hôpital du Jura bernois SA, Moutier, Switzerland
  2. 2Department of Surgery, Hôpital du Jura bernois SA, Moutier, Switzerland
  1. Correspondence to Dr Thomas Nierle, tomnierle{at}


Acute cerebellar ataxia is an infrequent neurological syndrome in adults especially if complicated by additional neurological deficits. We report the case of a 69-year-old woman who presented with sudden onset of left facial droop, dizziness, slurred speech and impaired balance. Her medical history included paroxysmal atrial fibrillation and a sigmoid diverticular abscess treated with ciprofloxacin and metronidazole. Cranial computed tomographic angiography and MRI showed no signs of acute ischaemia or haemorrhage but demonstrated symmetrically distributed lesions in the cerebellar dentate nuclei. A diagnosis of metronidazole-induced encephalopathy was suspected. Metronidazole was stopped and the patient completely recovered. Metronidazole is a commonly prescribed medication. Clinicians should be aware of the clinical and radiological presentation of metronidazole-induced encephalopathy so that this serious but completely reversible condition can be promptly diagnosed.

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