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Hussain SH, Zaidi M, Zaidi M, Grabau GM. Unraveling the Puzzle: A Case of Intricate Neurological Presentation Attributable to Hypomagnesemia. Cureus 2024; 16:e69273. [PMID: 39268027 PMCID: PMC11392027 DOI: 10.7759/cureus.69273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 09/15/2024] Open
Abstract
Hypomagnesemia can occasionally present with severe neurological deficiencies, and it is usually attributed to an underlying renal and/or gastrointestinal pathology. Rarely, patients may present with neurological symptoms in the absence of an obvious cause. Our case highlights the importance of considering hypomagnesemia as a primary cause of those presenting with severe neurological deficits in an intensive care unit setting, as well as the significance of conducting a thorough social and medical history on these patients to elucidate their underlying causes. We discuss the case of a 48-year-old Caucasian male who acutely presented with seizures, tremors, visual hallucinations, diplopia, personality changes, and ataxia with recurring severely low magnesium (0.4 mg/dL) at times in the absence of renal, gastrointestinal, hormonal, infectious, or autoimmune pathology.
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Affiliation(s)
- Syed H Hussain
- College of Osteopathic Medicine, Kansas City University, Joplin, USA
- Department of Internal Medicine, Freeman Hospital West, Joplin, USA
| | - Mohammed Zaidi
- College of Osteopathic Medicine, Kansas City University, Joplin, USA
- Department of Internal Medicine, Freeman Hospital West, Joplin, USA
| | - Mariam Zaidi
- College of Osteopathic Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
- Department of Internal Medicine, Freeman Hospital West, Joplin, USA
| | - Guy M Grabau
- Department of Internal Medicine, Freeman Hospital West, Joplin, USA
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Ray S, Park KW. Movement Disorders and Other Neurologic Impairment Associated With Hypomagnesemia: A Systematic Review. Neurol Clin Pract 2023; 13:e200202. [PMID: 37795503 PMCID: PMC10547470 DOI: 10.1212/cpj.0000000000200202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023]
Abstract
Purpose of Review The objective of this study was to explore the clinical spectrum of movement disorders and associated neurologic findings in hypomagnesemia and challenges in diagnosis and treatment. Recent Findings Sixty patients were identified in the literature for analysis. Movement disorders observed were postural tremor (23.3%, n = 14), resting tremor (8.3%, n = 5), intention tremor (10%, n = 6), ataxia involving the trunk (48.3%, n = 29) or limbs (25%, n = 15) and dysarthria (21.7%, n = 13), athetosis (8.3%, n = 5), myoclonus (6.7%, n = 4), and chorea (1.8%, n = 1). Symptoms may be accompanied by downbeat nystagmus, tetany, drowsiness, vertigo, and proximal muscle weakness. Residual deficits were noted in 16 (26.67%) patients. Serum magnesium was 1.3 mg/dL or lower in 53 patients (88.3%). Imaging findings include bilateral cerebellar (20%, n = 11) and vermis hyperintensities (9.09%, n = 5) and normal imaging. Proton pump inhibitors are the commonest etiology. Summary The movement disorders linked with hypomagnesemia can be associated with varied neurologic symptoms. A high degree of suspicion will enable early diagnosis to prevent residual deficits.
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Affiliation(s)
- Somdattaa Ray
- Division of Neurology, University of British Columbia
| | - Kye Won Park
- Division of Neurology, University of British Columbia
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Olmedo‐Saura G, Pérez‐Pérez J, Xuclà‐Ferrarons T, Collet R, Martínez‐Viguera A, Kulisevsky J. Cerebellar Syndrome Induced by Hypomagnesemia: A Treatable Cause of Ataxia Not to be Missed. Report of Three Cases and a Review of the Literature. Mov Disord Clin Pract 2023; 10:1004-1012. [PMID: 37332648 PMCID: PMC10272920 DOI: 10.1002/mdc3.13739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/02/2023] [Accepted: 03/23/2023] [Indexed: 10/06/2023] Open
Abstract
Background Magnesium is an important intracellular cation involved in essential enzymatic reactions. It is necessary for neuronal function and its depletion can produce neurological symptoms such as cramps or seizures. Clinical consequences of its deficit in the cerebellum are less known and the diagnosis can be delayed because of the lack of awareness on this condition. Cases We present three cases of cerebellar syndrome (CS) due to hypomagnesemia: A midline CS with myoclonus and ocular flutter and two cases of hemispheric CS, one of them entailed a Schmahmann's syndrome and the other suffered a seizure. MRI findings revealed cerebellar vasogenic edema and the symptoms improved after magnesium replacement in all cases. Literature Review We reviewed 22 cases of CS due to hypomagnesemia, all with subacute onset (days to weeks). Encephalopathy and/or epileptic seizures were common. MRI findings were vasogenic edema involving the cerebellar hemispheres, the vermis, or the nodule. Up to 50% of patients presented hypocalcemia and/or hypokalemia. All the patients showed symptomatic improvement after magnesium replacement, but 50% showed significant sequelae, and 46% relapsed. Conclusions Hypomagnesaemia should always be considered in the differential diagnosis of CS as it has a potential treatment, and its early recognition can avoid recurrences and permanent cerebellar impairment.
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Affiliation(s)
| | - Jesús Pérez‐Pérez
- Movement Disorders Unit, Neurology DepartmentSant Pau HospitalBarcelonaSpain
- Department of MedicineBarcelona Autonomous UniversityBarcelonaSpain
- Movement Disorders GroupBiomedical Research Institute‐Sant PauBarcelonaSpain
- Network Research Center‐Neurodegenerative Diseases (CIBERNED)MadridSpain
| | | | - Roger Collet
- Movement Disorders Unit, Neurology DepartmentSant Pau HospitalBarcelonaSpain
| | | | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology DepartmentSant Pau HospitalBarcelonaSpain
- Department of MedicineBarcelona Autonomous UniversityBarcelonaSpain
- Movement Disorders GroupBiomedical Research Institute‐Sant PauBarcelonaSpain
- Network Research Center‐Neurodegenerative Diseases (CIBERNED)MadridSpain
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Guerrero-Romero F, Micke O, Simental-Mendía LE, Rodríguez-Morán M, Vormann J, Iotti S, Banjanin N, Rosanoff A, Baniasadi S, Pourdowlat G, Nechifor M. Importance of Magnesium Status in COVID-19. BIOLOGY 2023; 12:735. [PMID: 37237547 PMCID: PMC10215232 DOI: 10.3390/biology12050735] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
A large amount of published research points to the interesting concept (hypothesis) that magnesium (Mg) status may have relevance for the outcome of COVID-19 and that Mg could be protective during the COVID disease course. As an essential element, Mg plays basic biochemical, cellular, and physiological roles required for cardiovascular, immunological, respiratory, and neurological functions. Both low serum and dietary Mg have been associated with the severity of COVID-19 outcomes, including mortality; both are also associated with COVID-19 risk factors such as older age, obesity, type 2 diabetes, kidney disease, cardiovascular disease, hypertension, and asthma. In addition, populations with high rates of COVID-19 mortality and hospitalization tend to consume diets high in modern processed foods, which are generally low in Mg. In this review, we review the research to describe and consider the possible impact of Mg and Mg status on COVID-19 showing that (1) serum Mg between 2.19 and 2.26 mg/dL and dietary Mg intakes > 329 mg/day could be protective during the disease course and (2) inhaled Mg may improve oxygenation of hypoxic COVID-19 patients. In spite of such promise, oral Mg for COVID-19 has thus far been studied only in combination with other nutrients. Mg deficiency is involved in the occurrence and aggravation of neuropsychiatric complications of COVID-19, including memory loss, cognition, loss of taste and smell, ataxia, confusion, dizziness, and headache. Potential of zinc and/or Mg as useful for increasing drug therapy effectiveness or reducing adverse effect of anti-COVID-19 drugs is reviewed. Oral Mg trials of patients with COVID-19 are warranted.
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Affiliation(s)
- Fernando Guerrero-Romero
- Biomedical Research Unit, Mexican Social Security Institute, Durango 34067, Mexico; (F.G.-R.); (L.E.S.-M.); (M.R.-M.)
| | - Oliver Micke
- Department of Radiation Therapy and Radiation Oncology, Franziskus Hospital, 33615 Bielefeld, Germany;
| | - Luis E. Simental-Mendía
- Biomedical Research Unit, Mexican Social Security Institute, Durango 34067, Mexico; (F.G.-R.); (L.E.S.-M.); (M.R.-M.)
| | - Martha Rodríguez-Morán
- Biomedical Research Unit, Mexican Social Security Institute, Durango 34067, Mexico; (F.G.-R.); (L.E.S.-M.); (M.R.-M.)
| | - Juergen Vormann
- Institute for Prevention and Nutrition, 85737 Ismaning, Germany;
| | - Stefano Iotti
- Department of Pharmacy and Biotechnology, Universita di Bologna, 40126 Bologna, Italy;
- National Institute of Biostructures and Biosystems, 00136 Rome, Italy
| | - Nikolina Banjanin
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Andrea Rosanoff
- CMER Center for Magnesium Education & Research, Pahoa, HI 96778, USA
| | - Shadi Baniasadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran 198396-3113, Iran;
| | - Guitti Pourdowlat
- Chronic Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran 198396-3113, Iran;
| | - Mihai Nechifor
- Department of Pharmacology, Gr. T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
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López Domínguez D, Álvarez-Cienfuegos JR, Vera Cáceres CH. Hypomagnesemia, a Rare Cause of Reversible Ataxia. Tremor Other Hyperkinet Mov (N Y) 2023; 13:15. [PMID: 37152624 PMCID: PMC10162194 DOI: 10.5334/tohm.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023] Open
Abstract
Background A 61-year-old male patient presented with cerebellar syndrome, which had progressively worsened for 10 days, followed by a tonic-clonic seizure. Phenomenology Shown Blood analysis showed severe hypomagnesemia and a brain MRI showed T2 hyperintensity in the cerebellar hemispheres (Figure 1). Therefore, the final diagnosis was cerebellar syndrome and epileptic seizures secondary to severe hypomagnesemia. Educational Value In cases of subacute onset of ataxia, the possibility of ataxia secondary to hypomagnesemia should be considered, as it can be diagnosed with a basic blood test and there are potentially life-threatening outcomes in the absence of treatment, with a reversible course following early supplementation.
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Affiliation(s)
- Daniel López Domínguez
- Movement Disorders Unit, Ataxia Unit, Neurology Department. Josep Tueta Hospital, Girona, Spain
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Kamm CP, Nyffeler T, Henzen C, Fischli S. Hypomagnesemia-Induced Cerebellar Syndrome-A Distinct Disease Entity? Case Report and Literature Review. Front Neurol 2020; 11:968. [PMID: 33013642 PMCID: PMC7505994 DOI: 10.3389/fneur.2020.00968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Clinical consequences of hypomagnesemia are manifold and include various neurological syndromes up to life-threatening conditions. Despite its importance, magnesium is generally not routinely determined leading to an under-recognition of hypomagnesemia-related disorders. In the past years, there are growing numbers of reports of hypomagnesemia-induced cerebellar syndromes (HiCS) with corresponding cerebellar edema, which might be a distinct disease entity. To provide further insights into HiCS, we describe a patient with HiCS and performed a literature review on cerebellar syndromes due to severe hypomagnesemia with regard to the clinical, MRI, and laboratory findings. We identified 17 cases, so including our case, 18 cases contribute to this review. Summarized, HiCS seems to be a distinct disease entity because of the remarkable similarities of clinical, MRI, and laboratory features. It should be diagnosed and treated early to avoid recurrent disease courses, residual symptoms, and potentially life-threatening conditions such as seizures. Physicians must be alert to HiCS as magnesium is usually not part of the routine electrolyte panel.
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Affiliation(s)
- Christian P Kamm
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christoph Henzen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Fischli
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, Lucerne, Switzerland
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