Fig. 6.

A 69 year old female with acutely altered mental status developed ATL after receiving high doses of metranidazole for over 2 months, prescribed for a recto-vaginal fistula. Her symptoms resolved after cessation of metronidazole. 6A-D: The reduced diffusion was symmetric and bilateral within the centrum semiovale (arrows) on DWI MRI (A) and ADC map (B), with hyperintensity on T2WI (C). Also, there was bilateral abnormal signal within the posterior limbs of the internal capsules (D, arrows) and midline callosal splenium (D, dotted arrow) on DWI. Notably, the dentate nuclei were normal in this patient (not shown); hence, this represents an atypical case of metronidazole toxicity causing ATL.