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Manganese neurotoxicity: a review of clinical features, imaging and pathology
1Neurodegenerative Disorders Centre, University of British Columbia, Vancouver, Canada.
Abstract:
Manganese intoxication can result in a syndrome of parkinsonism and dystonia. If these extrapyramidal findings are present, they are likely to be irreversible and even progress after termination of the exposure to manganese. Clinical features are usually sufficient to distinguish these patients from those with Parkinson's disease. The neurological syndrome does not respond to levodopa. Imaging of the brain may reveal MRI signal changes in the globus pallidus, striatum, and midbrain. Positron emission tomography reveals normal presynaptic and postsynaptic nigrostriatal dopaminergic function. The primary site of neurological damage has been shown by pathological studies to be the globus pallidus. The mechanism of toxicity is not clear.
Insights
Manganese intoxication causes irreversible parkinsonism and dystonia, distinct from Parkinson's disease. This neurological syndrome, affecting the globus pallidus, does not respond to levodopa treatment.
Area of Science:
- Neurology
- Toxicology
- Neuroimaging
Background:
- Manganese intoxication can lead to a distinct neurological syndrome characterized by parkinsonism and dystonia.
- These extrapyramidal symptoms may be irreversible and progress even after exposure cessation.
Purpose of the Study:
- To summarize the clinical, imaging, and pathological features of manganese intoxication-induced neurological syndrome.
- To differentiate this condition from Parkinson's disease.
Main Methods:
- Clinical observation and assessment of neurological findings.
- Review of brain imaging studies, including MRI and PET scans.
- Pathological study findings were considered.
Main Results:
- Neurological syndrome includes parkinsonism and dystonia, typically irreversible.
- Clinical features and lack of response to levodopa distinguish it from Parkinson's disease.
- MRI may show signal changes in globus pallidus, striatum, and midbrain; PET reveals normal dopaminergic function. Globus pallidus is the primary site of damage.
Conclusions:
- Manganese intoxication causes a unique neurological syndrome with specific clinical and imaging characteristics.
- The globus pallidus is identified as the primary site of neurological damage.
- The exact mechanism of manganese neurotoxicity remains unclear.