A Rare Cause of Acquired Non-Wilsonian Hepato-Cerebral Degeneration in a Middle-Aged Woman

Manganese is an essential trace mineral that has a vital role in maintaining various body functions. Manganese toxicity, referred to as Manganism, causing parkinsonism is a well-known phenomenon that occurs secondary to chronic environmental and occupational exposure to manganese. Patients with underlying chronic liver disease are also susceptible to the toxic accumulation of manganese since it essentially undergoes biliary excretion. At high serum concentrations, manganese can cross the blood-brain barrier and cause neuronal damage. We report an interesting case of a middle-aged woman with underlying chronic liver disease presenting to the medical admissions unit with features suggestive of parkinsonism, dystonia, and cerebellar dysfunction that developed secondary to manganese deposition in the basal ganglia of the brain. The report discusses important radiological features and also lays special emphasis on early recognition, clinical, radiological, and biochemical correlation, and early intervention.