Cytotoxic edema affecting distinct fiber tracts in ciguatera fish poisoning

Ciguatera fish poisoning (CFP) is the most common seafood toxin poisoning worldwide, caused by the consumption of reef fish contaminated with ciguatoxin (CTX).1 The neurotoxin is produced by specific microalgae termed dinoflagellates in shallow (sub-) tropical waters and from there transmitted through the food chain. CFP is characterized by variable gastrointestinal, cardiac, and neurologic symptoms, the latter typically comprising sensory disturbances such as hypoesthesia and paresthesia, cold allodynia, and myalgia. Headache, vertigo, ataxia, impaired consciousness, and cognitive problems are other facultative symptoms. Diagnosis of CFP is usually based on clinical grounds and exclusion. Despite the CNS being a major target of the toxin, only a few studies reported abnormal MRI findings so far.