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[Parkinsonism probably induced by manganese]
1Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España. jaduran@cica.es
Introduction:
In all cases of young persons with clinical Parkinson s disease it should be suspected that it is secondary to some primary disorder. Therefore a battery of diagnostic tests should be done before classification as idiopathic Parkinson s disease.
Clinical Case:
A 31 year old woman whose only previous illness had been Graves disease. She complained of difficulty with movements of her right arm and leg for some months (she had problems with walking and with rapid, repeated movements of her right hand). She also complained of tremor of her right limbs at rest. She denied taking drugs, having dysphagia, dysarthria, visual changes or sphincter disorders. Neurological examination showed her to have monotonous speech, slight facial hypomimia, slight reduction in spontaneous blinking, walking with less swing of her right arm; postural tremor of both arms, worse on the right; bradykinesia (2/4) of both right limbs and rigidity (1/4), axial and of the right limbs. The results of all the investigations done to rule out secondary Parkinsonism were normal, except for the plasma manganese level which was raised, although it returned to normal when the probable source of exposure to this metal was removed. However, the alterations of movement only disappeared after treatment with levodopa was started.
Conclusion:
In cases of Parkinsonism in young adults secondary causes should always be rules out, such as exposure to certain metals.
Insights
Parkinsonism in young adults may indicate a secondary cause, such as metal exposure. Prompt diagnosis and treatment, like levodopa, are crucial for symptom resolution.
Area of Science:
- Neurology
- Toxicology
Background:
- Parkinsonism in young individuals warrants investigation for secondary causes beyond idiopathic Parkinson's disease.
- A comprehensive diagnostic approach is essential before classifying Parkinsonism as idiopathic.
Observation:
- A 31-year-old woman with a history of Graves disease presented with right-sided limb movement difficulties and tremor.
- Neurological examination revealed symptoms consistent with Parkinsonism, including bradykinesia and rigidity.
- Elevated plasma manganese levels were detected, normalizing after removal of the suspected exposure source.
Findings:
- Standard investigations for secondary Parkinsonism were unremarkable.
- Despite normalization of manganese levels, motor symptoms persisted until levodopa treatment was initiated.
- This case highlights a potential link between manganese exposure and Parkinsonism, responsive to dopaminergic therapy.
Implications:
- Emphasizes the importance of screening for environmental and toxic exposures in young-onset Parkinsonism.
- Suggests that manganese toxicity should be considered in the differential diagnosis of unexplained Parkinsonism.
- Underscores the potential efficacy of levodopa in managing Parkinsonism secondary to certain toxic exposures.