Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 10488  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (569 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1177    
    Printed23    
    Emailed0    
    PDF Downloaded57    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGES
Year : 2017  |  Volume : 65  |  Issue : 5  |  Page : 1193

Isoniazid toxicity presenting as bilateral dentate hyperintensities


Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Web Publication6-Sep-2017

Correspondence Address:
Hima S Pendharkar
Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru - 560 029, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_249_17

Rights and Permissions



How to cite this article:
Deepesh A, Pendharkar HS. Isoniazid toxicity presenting as bilateral dentate hyperintensities. Neurol India 2017;65:1193

How to cite this URL:
Deepesh A, Pendharkar HS. Isoniazid toxicity presenting as bilateral dentate hyperintensities. Neurol India [serial online] 2017 [cited 2019 Aug 20];65:1193. Available from: http://www.neurologyindia.com/text.asp?2017/65/5/1193/214043




A 29-year old female patient presented with progressive ataxia over 20 days. She was on a 4-drug antituberculosis regime (including isoniazid [INH]) for a year due to the presence of multiple central nervous system tuberculomas.

Isoniazid neurotoxicity usually manifests with seizures, encephalopathy, and peripheral neuropathy; however, cerebellar ataxia is rare.[1] Reduction of gamma-aminobutyric acid levels[2] and downregulation of N-methyl-D-aspartate receptors are potential mechanisms for the dentate nuclei edema, and hence, the signal changes visualised on magnetic resonance imaging [Figure 1]. In developing countries, where tuberculosis is prevalent, INH toxicity should be included in the differential diagnosis of bilateral dentate nuclei hyperintensity, among other causes such as metronidazole[3] or methyl bromide toxicity,[4] as well as enteroviral infections,[5] or atypical Wernicke's encephalopathy.[6]
Figure 1: (a) T2 weighted image shows symmetric hyperintensity involving bilateral dentate nuclei. (b) Axial post-contrast T1 three-dimensional magnetization prepared rapid acquisition gradient reversal echo [MPRAGE] (three-dimensional inversion recovery) image did not reveal any abnormal postcontrast enhancement. There was no blooming on susceptibility weighted imaging or diffusion restriction (image not shown)

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wang HY, Chien CC, Chen YM, Huang CC. Encephalopathy caused by isoniazid in a patient with end stage renal disease with extrapulmonary tuberculosis. Ren Fail 2003;25:135-8.  Back to cited text no. 1
    
2.
Ishiwata Y, Nagata M, Yasuhara M. Effect of isoniazid on the pharmacodynamics of cefazolin-induced seizures in rats. Drug Metab Pharmacokinet 2005;20:117e20.  Back to cited text no. 2
    
3.
Puri V. Metronidazole neurotoxicity. Neurol India 2011;59:4-5.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Suwanlaong K, Phanthumchinda K. Neurological manifestation of methyl bromide intoxication. J Med Assoc Thai 2008;91:421-6.  Back to cited text no. 4
    
5.
Shen WC, Chiu HH, Chow KC, Tsai CH. MR imaging findings of enteroviral encephaloymelitis: An outbreak in Taiwan. AJNR Am J Neuroradiol. 1999;20:1889-95.  Back to cited text no. 5
    
6.
Shah VS, Shanmugam M, Kowsalya A, Srinivasan KG, Siddappa P, Vellaiappan N. Gestational Wernicke's encephalopathy. Neurol India 2017:65:1169-70.  Back to cited text no. 6
    


    Figures

  [Figure 1]

This article has been cited by
1 Isoniazid
Reactions Weekly. 2017; 1675(1): 142
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow