Olmedo-Saura Gonzalo, Pérez-Pérez Jesús, Xuclà-Ferrarons Tomás, Collet Roger, Martínez-Viguera Ana, Kulisevsky Jaime
Movement Disorders Unit, Neurology Department Sant Pau Hospital Barcelona Spain.
Department of Medicine Barcelona Autonomous University Barcelona Spain.
Mov Disord Clin Pract. 2023 Apr 17;10(6):1004-1012. doi: 10.1002/mdc3.13739. eCollection 2023 Jun.
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.
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.
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.
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.
镁是一种重要的细胞内阳离子，参与基本的酶促反应。它对神经元功能至关重要，其缺乏会产生诸如痉挛或癫痫发作等神经症状。小脑镁缺乏的临床后果鲜为人知，由于对这种情况认识不足，诊断可能会延迟。
我们报告三例因低镁血症导致的小脑综合征（CS）：一例伴有肌阵挛和眼球扑动的中线CS，以及两例半球性CS，其中一例伴有施马曼综合征，另一例发生癫痫发作。MRI检查结果显示小脑血管源性水肿，所有病例在补充镁后症状均有改善。
我们回顾了22例因低镁血症导致的CS病例，均为亚急性起病（数天至数周）。脑病和/或癫痫发作很常见。MRI检查结果为血管源性水肿，累及小脑半球、蚓部或小结。高达50%的患者出现低钙血症和/或低钾血症。所有患者在补充镁后症状均有改善，但50%的患者出现明显后遗症，46%的患者复发。
在CS的鉴别诊断中应始终考虑低镁血症，因为它有潜在的治疗方法，早期识别可避免复发和永久性小脑损伤。
