[A long-term organic brain syndrome and brain stem symptoms in an undiagnosed dialysis-associated encephalopathy]

Aluminium cycling in the soil-plant-animal-human continuum

A critical review of the literature on Al toxicity in plants, animals and humans reveals a similar mode of Al action in all living organisms, namely interference with the secondary messenger system (phosphoinositide and cytosolic Ca2+ signalling pathways) and enhanced production of reactive oxygen species resulting in oxidative stress. Aluminium uptake by plants is relatively quick (across the intact plasma membrane in < 30 min and across the tonoplast in < 1 h), despite huge proportion of Al being bound in the cell wall. Aluminium absorption in the animal/human digestive system is low (only about 0.1% of daily Al intake stays in the human body), except when Al is complexed with organic ligands (eg. citrate, tartarate, glutamate). Aluminium accumulates in bones and brain, with Al-citrate and Al-transferrin complexes crossing the blood-brain barrier and accumulating in brain cells. Tea plant and other Al-accumulator plant species contain large amounts of Al in the form of non-toxic organic complexes.

Subacute fatal aluminum encephalopathy after reconstructive otoneurosurgery: a case report

We report a 52-year-old woman who underwent otoneurosurgery to resect acoustic neurinoma. Bone reconstruction was performed with an aluminium (Al)-containing cement. Six weeks later the patient suffered from loss of consciousness, myoclonic jerks, and persistent grand mal seizures, clinical symptoms that resembled those of lethal dialysis encephalopathy of the 1960s and 1970s. She died 6 months later because of septic complications. Light- and electron-microscopic investigation of the central nervous system (CNS) showed pathognomonic Al-containing intracytoplasmic argyrophilic inclusions in choroid plexus epithelia, neurons, and cortical glia. These changes are characteristics of dialysis-associated encephalopathy (DAE), induced nowadays by long-term ingestion of Al-containing drugs (and with benign clinical courses). Atomic absorption spectrometry showed an increase of mean bulk Al concentration of the cortex and subcortex up to 9.3 microg/g (normal range <2 microg/g); laser microprobe showed the increase of Al in subcellular structures. This unique case again shows the extraordinary neurotoxicity of Al, which was, in our patient, initiated by an amount of about 30 mg Al and apparently caused by direct Al access to the brain parenchyma via a cerebrospinal fluid leakage.