Hypermagnesemic pseudocoma

M. A. Rizzo, M. Fisher and J. P. Lock
Department of Neurology, Medical Center of Central Massachusetts, Worcester.

We treated a case of iatrogenic hypermagnesemia that clinically mimicked a central brain-stem herniation syndrome. Hypermagnesemia (magnesium level, 9.85 mmol/L [24 mg/dL]) can cause parasympathetic blockade, inducing fixed and dilated pupils, in addition to neuromuscular blockade. Extreme hypermagnesemia can therefore mimic a midbrain syndrome and cause a pseudocomatose state.

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