[Toxic aluminum encephalopathy. Predominant involvement of the limbic system on MRI].
Two patients underwent acoustic schwannoma surgery by transmastoid approach. Petrous bone defect was filled in with aluminium-containing bone cement (Ionocem). A pseudomeningocele by CSF accumulation in subcutaneous temporoparietal area appeared after the procedure and, in subsequent weeks, encephalopathy with confusion and seizures. MRI showed cerebral involvement with herpes-like disposition. Temporal stereotactic biopsy in a case did not confirm viral encephalitis but disclosed cellular accumulation of lipofucsin and particles highly suggestive of aluminum-inclusions. Aluminium's levels in blood and CSF of both patients were very high and confirm the brain's toxic involvement. Aluminium's toxicity would be advocated in patients with neurologic disorders who have undergone maxillofacial or skull bone-cementoplasty by an aluminum-containing biomaterial, if this cement is in contact with CSF.
Lévêque
C
C
Service d'Imagerie médicale, Hôpital du Val-de-Grâce, Paris.
Soulié
D
D
Sarrazin
J L
JL
Hor
F
F
Desgeorges
M
M
Cordoliani
Y S
YS
D000368:Aged; D000535:Aluminum / Q000009:adverse effects* / Q000097:blood / Q000134:cerebrospinal fluid; D000538:Aluminum Silicates / Q000009:adverse effects* / Q000097:blood / Q000134:cerebrospinal fluid; D001672:Biocompatible Materials / Q000009:adverse effects*; D001843:Bone Cements / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced / Q000473:pathology; D003221:Confusion / Q000139:chemically induced; D003937:Diagnosis, Differential; D018792:Encephalitis, Viral / Q000175:diagnosis; D005260:Female; D005899:Glass Ionomer Cements / Q000009:adverse effects*; D006801:Humans; D008032:Limbic System / Q000187:drug effects* / Q000473:pathology; D008062:Lipofuscin / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008588:Meningocele / Q000134:cerebrospinal fluid / Q000209:etiology; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery; D010579:Petrous Bone / Q000601:surgery; D012640:Seizures / Q000139:chemically induced
D000538:Aluminum Silicates; D001672:Biocompatible Materials; D001843:Bone Cements; D005899:Glass Ionomer Cements; D008062:Lipofuscin; C088058:polymaleinate ionomer; D000535:Aluminum
Encéphalopathie toxique à l'aluminium. Atteinte prédominante du système limbique en IRM.