Teaching NeuroImage: Selenium Toxicity Causing Cerebellar Lesions With Sparing of Dentate Nucleus

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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 110-230 and 10-100 μg/L).After stopping selenium supplements, her symptoms gradually improved.