Cerebral vasospasm and wernicke encephalopathy secondary to adult cyclic vomiting syndrome: the role of magnesium

Magnesium has a regulatory role in the excitability of cell membranes, and is also a cofactor in the phosphorylation of thiamine. Hypomagnesemia has been associated with coronary vasospasm, but its role in cerebrovascular pathology is controversial, and cerebral vasospasm exclusively attributable to...

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Bibliographic Details
Published in:BMC neurology 2016-08, Vol.16 (1), p.135-135, Article 135
Main Authors: Sánchez-Larsen, Álvaro, Segura, Tomás, García-Muñozguren, Susana, Peinado-Ródenas, Javier, Zamarro, Joaquín, Hernández-Fernández, Francisco
Format: Article
Language:English
Subjects:
Care and treatment
Case Report
Cerebral ischemia
Complications and side effects
Diagnosis, Differential
Encephalopathy
Health aspects
Humans
Kidney Diseases - complications
Magnesium - blood
Magnesium in the body
Male
Middle Aged
Omeprazole - adverse effects
Proton Pump Inhibitors - adverse effects
Risk factors
Thiazides - adverse effects
Vasospasm, Intracranial - blood
Vasospasm, Intracranial - etiology
Vomiting
Vomiting - complications
Vomiting - drug therapy
Wernicke Encephalopathy - blood
Wernicke Encephalopathy - diagnosis
Wernicke Encephalopathy - etiology
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Summary:Magnesium has a regulatory role in the excitability of cell membranes, and is also a cofactor in the phosphorylation of thiamine. Hypomagnesemia has been associated with coronary vasospasm, but its role in cerebrovascular pathology is controversial, and cerebral vasospasm exclusively attributable to hypomagnesemia has not been reported in humans. We report the case of a 51-year-old man in whom uncontrollable vomiting, treatment with omeprazole and thiazide, and renal impairment lead to a severe hypomagnesemia (magnesium below the level of detection in blood tests), which secondarily caused Wernicke's encephalopathy and vasospasm in multiple cerebral arteries (seen with cerebral angiography and CT angiography) that presented with a complete right hemisphere neurological deficit. These disturbances completely resolved when magnesium levels were normalized and subsequent neuroimaging tests confirmed the resolution of angiographic changes. Our case suggests that hypomagnesemia should be considered in the differential diagnosis of patients with neurological symptoms and predisposing causes.
ISSN:1471-2377
1471-2377
DOI:10.1186/s12883-016-0660-x