Thread by @PearlsNeurology

A brief refresher about #Antibiotic-associated #Encephalopathy #Twittorial #Tweetorial #AMS
Inspired from today's #NoonConference topic
#MedTwitter #MedStudentTwitter #NeuroTwitter #NeurotwitterNetwork #MedEd @MedTweetorials #NeurologyResident #Neurology #RITEReview

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Antibiotics are commonly prescribed medications in the inpatient and outpatient setting and it's important to recognize #AdverseEvents, including idiosyncratic reactions, such as #encephalopathy.

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Antibitiotics associated with #Encephalopathy:
- Beta lactams
- #Cephalosporins (#Cefepime is the most common,
Ceftazidime)
- Imipenem
- #Penicillin procaine
- Fluoroquinolones
- Macrolides (clarithromycin)
- TMP-SMX
- #Metronidazole
- Isoniazid

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#Psychosis can be found in almost 50% of cases, most commonly associated with:
- Sulfonamides
- Quinolones
- Macrolides
- Penicillin procaine

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#Seizures can be present and are commonly associated with #penicillin and #cephalosporins, but can also be present with quinolones, macrolides and #metronidazole

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#Myoclonus usually present with #Penicillin and #cephalosporins

In #Encephalopathy (that can include #seizures) + Acute #cerebellar syndrome, look for chronic/long-term use of #metronidazole. Usually accompanied with an abnormal #BrainMRI.

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MRI brain T2 FLAIR hyperintensities are most commonly seen in dentate nucleus of the #cerebellum, but can also involve the #brainstem and #splenium of the corpus callosum.

radiopaedia.org/cases/metronid…

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Language dysfunction (#aphasia) has also been described with #Cefepime.

In addition: #peripheralneuropathy has been associated with #metronidazole, #fluoroquinolones, #Linezolid, #chloramphenicol, #Isoniazid and #nitrofurantoin.

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Important #lab investigations:
- EEG (usually abnormal with penicillin and cephalosporins)
- MRI brain (normal with all antibiotics, except metronidazole)
- Renal function tests
- Liver function tests

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Most common #EEG abnormality: slowing and Geneneralized periodic discharges with #triphasic morphology.
#Epileptiform discharges or seizures can be present with #penicillin, #cephalosporins, #quinolones.
Don-t forget non-convulsive status!

Image from: e-jnc.org/upload/pdf/jnc…
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Lastly, onset of encephalopathy usually occurs within 5 days of starting the antibiotic, except for #metronidazole (3 weeks) and #isoniazid (weeks-months).

Early identification of possible antibiotic involved and discontinuation will improve patient outcomes.

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References:
pubmed.ncbi.nlm.nih.gov/26888997/
journals.lww.com/continuum/page…

Feel free to add/correct/comment to make the review more complete! @MLotiaMD @hisham_gb @shilpahaldal @beccaprattmd @MoustafaAlyMD @drruchabahekar @krishnaomc @LeeArcherMD @UAMS_EM @VizcarraJA @pdrake85 @ezgi_saylam

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@threadreaderapp please unroll.