Drug-induced changes in dentate nuclei of cerebellum

Sir,

We read with great interest the article titled “Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy” by Singh et al. in the April–June 2017 issue of the Indian Journal of Radiology and Imaging.[1] The article is highly informative and describes signal changes in splenium and dentate nuclei following metronidazole ingestion. In this article, we describe a few drugs that cause similar signal changes in the cerebellar dentate nuclei [Table 1]:

Table 1

Drugs that cause signal change in dentate nuclei

Drug	Use	Area of brain affected	T2/FLAIR hyperintense	Resolution upon discontinuation of drug
A[1],[2] Metronidazole	Antibiotic, amebicide, antiprotozoal agent	Dentate nuclei, midbrain, inferior colliculus, dorsal pons and medulla, inferior olivary nucleus, splenium	Yes, shows diffusion restriction	Yes
B[2] Monohalothane	Fumigative pesticide	Dentate nuclei, periaqueductal region of midbrain, inferior colliculus, splenium, globus pallidus, thalamus, lower cranial nerve nuclei	Yes, no diffusion restriction	Yes
C[3] Isoniazid	First line antitubercular therapy	Dentate nuclei	Yes, may show diffusion restriction	Yes
D[2],[4] Cycloserine	Second line antitubercular therapy	Dentate nuclei	Yes, shows diffusion restriction	Yes

Thus, we see that the dentate nuclei can be affected by many drugs with nonspecific magnetic resonance imaging findings. Hence, integration of clinical data is crucial for definitive diagnosis.[4]

Conflict of Interest

There are no conflicts of interest.

• References

• 1 Singh R, Kaur R, Pokhariyal P, Aggarwal R. Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy. Indian J Radiol Imaging 2017; 27: 129-32
• 2 Khadilkar S, Jaggi S, Patel B, Yadav R, Hanagandi P, Faria do Amaral LL. A practical approach to diseases affecting dentate nuclei. Clin Radiol 2016; 71: 107-19
• 3 Peter P, John M. Isoniazid-induced cerebellitis: A disguised presentation. Singapore Med J 2014; 55: e17-9
• 4 Kim S, Kang M, Cho JH, Choi S. Reversible magnetic resonance imaging findings in cycloserine-induced encephalopathy: A case report. Neurol Asia 2014; 19: 417-9

Publication History

Article published online:
26 July 2021