title: Cerebral vasospasm and wernicke encephalopathy secondary to adult cyclic vomiting syndrome: the role of magnesium.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Our case suggests that hypomagnesemia should be considered in the differential diagnosis of patients with neurological symptoms and predisposing causes.
authors: Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. aa.sanchezlarsen@gmail.com.
authors: Álvaro
authors: http://orcid.org/0000-0003-2134-4980
authors: Á
authors: Sánchez-Larsen
authors: Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors: Tomás
authors: T
authors: Segura
authors: Department of Neurology, Grupo Hospitales de Madrid, Madrid, Spain.
authors: Susana
authors: S
authors: García-Muñozguren
authors: Department of Radiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors: Javier
authors: J
authors: Peinado-Ródenas
authors: Unit of Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors: Joaquín
authors: J
authors: Zamarro
authors: Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.|Unit of Interventional Neuroradiology, Department of Radiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors: Francisco
authors: F
authors: Hernández-Fernández
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008274:Magnesium / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D049971:Thiazides / Q000009:adverse effects; D020301:Vasospasm, Intracranial / Q000097:blood / Q000209:etiology; D014839:Vomiting / Q000150:complications / Q000188:drug therapy*; D014899:Wernicke Encephalopathy / Q000097:blood / Q000175:diagnosis / Q000209:etiology*
chemical_list: D054328:Proton Pump Inhibitors; D049971:Thiazides; D008274:Magnesium; D009853:Omeprazole
keywords: Case report; Cerebral vasospasm; Cyclic vomiting syndrome; Hypomagnesemia; Wernicke encephalopathy