MRI-negative cerebellar syndrome caused by medication-induced magnesium deficiency: a case report.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Marvin Jüchtern
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引用次数: 0

Abstract

Background: Cerebellar pathologies in adults can have a wide range of hereditary, acquired and sporadic-degenerative causes. Due to the frequency in daily hospital, especially intensive care, settings, electrolyte imbalances are an important, yet rare differential diagnosis. The hypomagnesemia-induced cerebellar syndrome (HiCS) constitutes a relevant disease entity with clinical and morphological variability due to a potential progression of symptoms and a promising causal treatment. Cases of HiCS without imaging abnormalities are scarcely reported and pose a particular challenge to practitioners.

Case presentation: A 68-year-old female patient presented with subacute onset gait impairment and concomitant vertigo. Gaze induced nystagmus, ataxia and limb dysmetria became objectifiable. A broad diagnostic workup, including liquor puncture, whole-body positron emission tomography, antibody serology and most notably thin-layer magnetic resonance imaging remained unconclusive. Only a more detailed examination of chronic hypokalemia with the detection of severe magnesium deficiency under the intake of proton pump inhibitors and a recent gastrointestinal infection found a causal treatment through electrolyte substitution.

Conclusions: Electrolyte disorders as a reason for central nervous pathologies remain underdiagnosed and underestimated, as a heterogeneous clinical appearance, the growing number of defined cerebellar diseases and, like in our case, lacking imaging abnormality aggravatingly contrast with a high intake prevalence of triggering medication. The presence of diarrhea or vomiting, electrolyte shortage, cardiac arrhythmia, alcoholism and particularly the intake of proton pump inhibitors in patients with cerebellar symptoms should result in thorough electrolyte diagnostics. Early recognition of this causally treatable cerebellar syndrome and prompt discontinuation of triggering medication are crucial to improve the often poor prognosis.

Abstract Image

药物性缺镁所致mri阴性小脑综合征1例。
背景:成人小脑病变可以有广泛的遗传、获得性和散发性退行性原因。由于在日常医院,特别是重症监护,设置频率,电解质失衡是一个重要的,但罕见的鉴别诊断。低镁诱导的小脑综合征(HiCS)是一种相关的疾病实体,由于症状的潜在进展和有希望的因果治疗,具有临床和形态学的可变性。没有影像学异常的HiCS病例很少报道,并对从业者提出了特殊的挑战。病例介绍:一名68岁女性患者,表现为亚急性起病步态障碍并伴有眩晕。凝视引起的眼球震颤、共济失调和肢体障碍变得客观化。广泛的诊断检查,包括液体穿刺,全身正电子发射断层扫描,抗体血清学和最值得注意的薄层磁共振成像仍然没有定论。只有对慢性低钾血症进行更详细的检查,并在摄入质子泵抑制剂和最近的胃肠道感染的情况下检测到严重的缺镁,才发现通过电解质替代的因果治疗。结论:电解质紊乱作为中枢神经病变的原因仍未得到充分的诊断和低估,作为一种异质性的临床表现,越来越多的小脑疾病被定义,像我们的病例一样,缺乏影像学异常,与高剂量的触发性药物形成鲜明对比。出现腹泻或呕吐、电解质缺乏、心律失常、酒精中毒,特别是摄入质子泵抑制剂的小脑症状患者,应进行彻底的电解质诊断。早期认识到这种因果可治疗的小脑综合征和及时停止触发药物是改善往往不良预后的关键。
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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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