Cerebellar Syndrome From Proton Pump Inhibitor-Induced Hypomagnesemia: Two Reversible but Relapsing Cases

Area of Science:

• Neurology
• Emergency Medicine
• Clinical Biochemistry

Background:

• Cerebellar syndromes present diagnostic challenges in emergency settings.
• Differential diagnoses include stroke, multiple sclerosis, toxins, and metabolic imbalances like hypomagnesemia.
• Proton pump inhibitors (PPIs) are increasingly linked to severe hypomagnesemia.

Purpose of the Study:

• To highlight PPI-induced hypomagnesemia as a cause of reversible cerebellar syndrome.
• To present clinical cases illustrating this association.
• To emphasize the importance of considering hypomagnesemia in patients with unexplained cerebellar symptoms.

Main Methods:

• Case report analysis of two patients with cerebellar dysfunction.
• Investigation of hypomagnesemia as a potential cause.
• Assessment of response to magnesium supplementation.

Main Results:

• Two patients with PPI-associated hypomagnesemia presented with cerebellar symptoms (dizziness, instability).
• Magnesium supplementation led to significant clinical improvement in both cases.
• Normal brain imaging did not exclude hypomagnesemia as the cause.

Conclusions:

• PPI-induced hypomagnesemia is a crucial, often overlooked cause of cerebellar dysfunction.
• Early diagnosis and magnesium repletion can reverse symptoms.
• Regular monitoring of magnesium levels is essential for patients on long-term PPI therapy.