Hypomagnesaemia induced recurrent cerebellar ataxia: an interesting case with successful management

Singh Saraj Kumar,Goel Khushbu,Mukherji Joy Dev

doi:10.1186/s40673-019-0110-9

Singh Saraj Kumar, Goel Khushbu + Show 1 more

Open Access

https://doi.org/10.1186/s40673-019-0110-9

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Abstract

PurposeSevere Hypomagnesaemia is a rare biochemical findings utilized for identifying the etiology of cerebellar ataxia. It requires a high degree of suspicion to diagnose. MRI findings are often nonspecific.MethodsThe author presents a case of 38 yrs. old male patient presented with vomiting, gait imabalance and nystagmus. Biochemical investigations lead to severe hypomagnesaemia. Also MRI findings were matched suggesting of hyperintesity in left cerebellar hemisphere.ResultsPatient was treated with magnesium infusion which leads to recovery of patient. Again the same symptomology was repeated after 3 months and disappearance after same treatment. Offending cause was diagnosed and proton pump inhibitors stopped.ConclusionSevere Hypomagnesaemia is a rare but treatable cause if diagnosed at right time. It requires a high degree of suspicion to diagnose it. Measurement of serum magnesium levels should always be kept in back of mind if definite management of cerebellar symptoms has to be done.

Highlights

Magnesium is a critical intracellular cation which is useful in many steps of enzymatic reactions
Low levels of magnesium can result in endovascular epithelium dysfunction that can present with clinical picture resembling posterior reversible encephalopathy
The author is describing a young patient presented with cerebellar syndrome associated with hypomagnesaemia, which got corrected on normalizing the magnesium level

Summary

Introduction

Magnesium is a critical intracellular cation which is useful in many steps of enzymatic reactions. Low levels of magnesium can result in endovascular epithelium dysfunction that can present with clinical picture resembling posterior reversible encephalopathy. Its improvement on correction of serum magnesium level is rarely reported. The author is describing a young patient presented with cerebellar syndrome associated with hypomagnesaemia, which got corrected on normalizing the magnesium level. Serum Vitamin B12 levels were in normal range. Came back with multiple episodes of whole body stiffness, uprolling of eyes, vigorous shaking, irritability, Short term memory loss, night time hallucinations. This time Serum magnesium levels were 0.9 mg/dl. Magnetic Resonance Imaging (MRI) brain at the time of admission was showing hyperintensity at left cerebellar hemisphere which disappeared after 4 weeks of definite management. Magnetic Resonance Imaging (MRI) brain at the time of admission was showing hyperintensity at left cerebellar hemisphere which disappeared after 4 weeks of definite management. (Fig. 1a and b)

Discussion

Conclusion