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Parkinsonism caused by chronic usage of intravenous potassium permanganate

Hasan Meral1, Yasar Kutukcu, Birgul Atmaca

  • 1Department of Neurology, Haseki Educational and Research Hospital, Istanbul, Turkey.

The Neurologist
|March 14, 2007
PubMed
Abstract

Insights

Chronic manganese overexposure can cause atypical parkinsonism. This condition may present with specific brain MRI findings, particularly in the basal ganglia, and often does not respond to levodopa treatment.

Area of Science:

  • Neuroscience
  • Toxicology
  • Radiology

Background:

  • Chronic manganese (Mn) overexposure is linked to neuronal degeneration and parkinsonism.
  • Manganese intoxication can manifest with characteristic abnormalities on T1-weighted MRI, including hyperintensity in the globus pallidus and substantia nigra.

Observation:

  • Two cases of manganese intoxication are presented, resulting from parenteral administration of a psychostimulant mixture.
  • Patients exhibited parkinsonism symptoms, extrapyramidal disturbances, and a distinctive "cock walk," with one case showing tremor and the other lacking it.

Findings:

  • Cranial MRI revealed bilateral, symmetric T1-weighted hyperintensities in the globus pallidus, indicative of manganese accumulation.
  • Unlike some reported cases, the patients in this study showed no response to levodopa treatment.

Implications:

  • Manganese intoxication can lead to an atypical form of parkinsonism.
  • Characteristic basal ganglia T1 signal hyperintensities on MRI are associated with manganese exposure.
  • The lack of levodopa response in these cases highlights the varied clinical presentations of manganese-induced parkinsonism.

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