Teaching NeuroImage: Selenium Toxicity Causing Cerebellar Lesions With Sparing of Dentate Nucleus | Neurology
A 58-year-old woman presented with 2 weeks of dizziness and unsteady gait. Examination revealed broad-based ataxic gait. Routine blood and CSF tests were normal. Brain MRI showed a symmetric abnormal signal in bilateral brainstem and cerebellum, indicating a systematic toxic or metabolic disorder (Figure). The patient endorsed a 7-year history of taking selenium supplements. The blood and urine selenium levels were 569.3 and 287.3 μg/L, respectively, more than 2 times higher than normal (reference range