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Metronidazole, a 5-nitroimidazole widely used for treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections, produces a number of neurologic side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures [1-3]. We report brain MRI findings in a patient with metronidazole-induced sensory neuropathy, encephalopathy, and cerebellar dysfunction. To our knowledge there are no previous reports of brain MRI changes due to metronidazole toxicity. Case report. A 45-year-old Asian Indian woman who had been living in the United States for the past 10 years was hospitalized with complaints of confusion, gait unsteadiness, and painful extremities. About 1 month prior to admission the patient had returned from India, where she had a brief episode of diarrhea with fever that was treated with shots. Two days after returning from her trip, the patient was hospitalized with abdominal pain and diarrhea. Abdominal ultrasound revealed cholecystitis, and stool examination was positive for Blastocystis hominis, resulting in the patient's being started on metronidazole 750 mg three times a day. Two weeks later, she developed wrist and hand arthralgias and was prescribed ibuprofen and amitriptyline at night for sleep. Laboratory investigation at this time revealed an ESR of 24 mm/hr, normal complete blood counts, CK of 54, negative antinuclear antibodies screen, and mildly elevated rheumatoid arthritis factor at 66 IU/ml (reference, <40). One week later, she complained of difficulty in hearing and bilateral ankle pain. She denied any fever, chills, or night sweats. Examination did not reveal any inflammation of the …