Vestibular Disorders after Kidney Transplantation: Focus on the Pathophysiological Mechanisms Underlying the Vertical Nystagmus Associated with Tacrolimus-Related Hypomagnesamia

Pasquale Viola, Vincenzo Marcelli, Domenico Sculco, Davide Pisani, Alfredo Caglioti, Filippo Ricciardiello, Alfonso Scarpa, Alessia Astorina, Giuseppe Tortoriello, Luca Gallelli, Giovambattista De Sarro and Giuseppe Chiarella
Additional contact information
Pasquale Viola: Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, 88100 Catanzaro, Italy
Vincenzo Marcelli: UOC ENT Ospedale del Mare, 80147 Naples, Italy
Domenico Sculco: Unit of Audiology, Mater Domini University Hospital, 88100 Catanzaro, Italy
Davide Pisani: Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, 88100 Catanzaro, Italy
Alfredo Caglioti: Nephrology and Dialysis Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy
Filippo Ricciardiello: ENT Department, AORN Cardarelli, 80131 Napoli, Italy
Alfonso Scarpa: Department of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy
Alessia Astorina: Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, 88100 Catanzaro, Italy
Giuseppe Tortoriello: UOC ENT Ospedale del Mare, 80147 Naples, Italy
Luca Gallelli: Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” Hospital, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
Giovambattista De Sarro: Operative Unit of Pharmacology and Pharmacovigilance, “Mater Domini” Hospital, Department of Health Science, University Magna Graecia, 88100 Catanzaro, Italy
Giuseppe Chiarella: Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, 88100 Catanzaro, Italy

IJERPH, 2022, vol. 19, issue 4, 1-7

Abstract: The purpose of this paper is to present the case of a patient undergoing kidney transplantation who developed limb tremor dizziness and vertical nystagmus (ny) during Tacrolimus (TAC) therapy and to investigate the pathophysiological mechanisms underlying the balance disorder. This case study regards a 51-year old kidney transplant male patient with hand tremors and lower limbs asthenia associated with dizziness and nausea. The symptoms started two months after the beginning of intravenous TAC for renal transplantation. The pure-tone audiometry showed a mild symmetrical high-frequencies down-sloping sensorineural hearing loss. Acoustic emittance measures showed a normal tympanogram; stapedial reflexes were normally elicited. The Auditory Brainstem Responses (ABR) and Cervical Vestibular Evoked Myogenic Potentials (c-VEMPs) were bilaterally normally evoked. The bedside vestibular examination showed spontaneous down-beating stationary persistent, omni-positional nystagmus, not inhibited by fixation. The Head-Shaking Test accentuates the spontaneous ny. The horizontal clinical head impulse test was negative, bilaterally. A biochemical blood test revealed a decrease in Magnesium (Mg) levels (0.8 mg/dL; normal range 1.58–2.55). The integration of Mg induced both a plasma levels normalization and an improvement of clinical symptoms. This case suggests that TAC treatment can induce a Mg depletion that caused the transient cerebellar lesion. Therefore, the monitoring of serum electrolytes during immunosuppressive treatment appears to be a useful tool in order to reduce the central system symptomatology.

Keywords: vertical nystagmus; hypomagnesemia; tacrolimus; kidney transplantation; vestibular disorder (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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