Subacute fatal aluminum encephalopathy after reconstructive otoneurosurgery: A case report

We report a 52-year-old woman who underwent otoneurosurgery to resect acoustic neurinoma. Bone reconstruction was performed with an aluminium (Al)-containing cement. Six weeks later the patient suffered from loss of conciousness, myoclonic jerks, and persistent grand mal seizures, clinical symptoms...

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Bibliographic Details
Published in:Human pathology 2001-10, Vol.32 (10), p.1136-1140
Main Authors: Reusche, Erich, Pilz, Peter, Oberascher, Gerhard, Lindner, Buko, Egensperger, Rupert, Gloeckner, Katharina, Trinka, Eugen, Iglseder, Bernhard
Format: Article
Language:English
Subjects:
aluminum
Aluminum - analysis
Aluminum - poisoning
Aluminum Silicates - adverse effects
Aluminum Silicates - chemistry
atomic absorption spectrometry
Biocompatible Materials - adverse effects
Biocompatible Materials - chemistry
Biological and medical sciences
Bone Cements - adverse effects
Bone Cements - chemistry
Brain - drug effects
Brain - metabolism
Brain - pathology
Brain Chemistry
Brain Diseases - chemically induced
Brain Diseases - pathology
dialysis
Ear, Inner - surgery
encephalopathy
Fatal Outcome
Female
Glass Ionomer Cements - adverse effects
Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics
Humans
laser microprobe
Medical sciences
Middle Aged
morphology
Postoperative Complications
seizures
Seizures - etiology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the ear, the auditive nerve and the facial nerve
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Summary:We report a 52-year-old woman who underwent otoneurosurgery to resect acoustic neurinoma. Bone reconstruction was performed with an aluminium (Al)-containing cement. Six weeks later the patient suffered from loss of conciousness, myoclonic jerks, and persistent grand mal seizures, clinical symptoms that resembled those of lethal dialysis encephalopathy of the 1960s and 1970s. She died 6 months later because of septic complications. Light- and electron-microscopic investigation of the central nervous system (CNS) showed pathognomonic Al-containing intracytoplasmic argyrophilic inclusions in choroid plexus epithelia, neurons, and cortical glia. These changes are characteristics of dialysis-associated encephalopathy (DAE), induced nowadays by long-term ingestion of Al-containing drugs (and with benign clinical courses). Atomic absorption spectrometry showed an increase of mean bulk Al concentration of the cortex and subcortex up to 9.3 μg/g (normal range
ISSN:0046-8177
1532-8392
DOI:10.1053/hupa.2001.28251