TOXIC ALUMINIC ENCEPHALOPATHY - LIMBIC SY STEM INVOLVEMENT ON MRI

Two patients underwent acoustic schwannoma surgery by transmastoid app roach. Petrous bone defect was filled in with aluminium-containing bon e cement (Ionocem(R)). A pseudomeningocele by CSF accumulation in subc utaneous temporoparietal area appeared after the procedure and, in sub sequent weeks, encephalopathy with confusion and seizures. MRI showed cerebral involvement with herpes-like disposition. Temporal stereotact ic biopsy in a case did not confirm viral encephalitis but disclosed c ellular accumulation of lipofucsin and particles highly suggestive of aluminum-inclusions. Aluminium's levels in blood and CSF of both patie nts were very high and confirm the brain's toxic involvement. Aluminiu m's toxicity would be advocated in patients with neurologic disorders who have undergone maxillofacial or skull bone-cementoplasty by an alu minum-containing biomaterial, if this cement is in contact with CSF.