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MALDI Imaging Mass Spectrometry of Neuropeptides in Parkinson's Disease
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Dopamine transporter SPECT of a liver cirrhotic with atypical parkinsonism

Jongchul Kim1, Jong-Min Kim, Yu Kyeong Kim

  • 1Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea.

Industrial Health
|July 20, 2007
PubMed

Insights

High manganese exposure causes manganism, a distinct neurological syndrome differing from Parkinson's disease. Brain imaging in a patient with liver cirrhosis showed findings consistent with manganism, not Parkinson's.

Area of Science:

  • Neurology
  • Toxicology
  • Neuroimaging

Background:

  • Manganese (Mn) is an essential trace element, but excessive exposure can lead to a distinct neurological syndrome known as manganism.
  • Manganism shares some clinical features with idiopathic Parkinson's disease (PD), leading to diagnostic challenges.
  • Hepatic dysfunction can impair manganese excretion, increasing the risk of neurotoxicity.

Observation:

  • This study describes a case of atypical parkinsonism in a patient with liver cirrhosis and elevated blood manganese levels.
  • Clinical presentation included features suggestive of parkinsonism.
  • The patient underwent [123I]-fluoropropyl (FP)-CIT SPECT imaging and brain MRI.

Findings:

  • [123I]-FP-CIT SPECT revealed normal dopamine transporter (DAT) uptake in the striatum, with scattered hypodense regions.
  • Brain MRI showed increased signal intensity in the globus pallidus on T1-weighted images.
  • These neuroimaging findings are characteristic of manganism.

Implications:

  • Distinguishing manganism from PD is crucial for appropriate management and prognosis.
  • Neuroimaging plays a vital role in differentiating these conditions.
  • This case highlights the importance of considering environmental and occupational exposures in the differential diagnosis of parkinsonism, especially in patients with comorbidities affecting metal metabolism.

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