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Manganese induced parkinsonism: a case report
1Department of Neurology, Dong-A University College of Medicine, Pusan, Korea. jwkim1@seunghak.donga.ac.kr
Abstract:
Manganese (Mn) intoxication is known to induce parkinsonism. Mn-induced parkinsonism preferentially affect the globus pallidus in contrast to idiopathic parkinsonism where degeneration predominantly involves the nigral pars compacta. We describe a 51-year-old man who had been occupationally exposed to Mn. He had parkinsonian features including masked face, resting tremor, and bradykinesia. He also had a cock walk and a particular propensity to fall in a backward gait. There was no sustained therapeutic response to levodopa. A fluorodopa PET scan was normal. This case indicates that Mn-induced parkinsonism can be differentiated from idiopathic parkinsonism in that the former has unique clinical features and a normal fluorodopa PET scan.
Insights
Manganese intoxication causes parkinsonism affecting the globus pallidus, distinct from idiopathic parkinsonism. This manganese-induced condition shows unique symptoms and a normal fluorodopa PET scan.
Area of Science:
- Neuroscience
- Toxicology
- Neurology
Background:
- Manganese (Mn) intoxication is a recognized cause of parkinsonism.
- Mn-induced parkinsonism typically targets the globus pallidus, unlike idiopathic parkinsonism which predominantly affects the nigral pars compacta.
Observation:
- A 51-year-old man with occupational manganese exposure presented with parkinsonian symptoms.
- Clinical features included masked face, resting tremor, bradykinesia, a "cock walk" gait, and a tendency to fall backward.
- The patient showed no improvement with levodopa treatment.
Findings:
- A fluorodopa Positron Emission Tomography (PET) scan was normal.
- This suggests a potential diagnostic differentiator between manganese-induced and idiopathic parkinsonism.
Implications:
- Manganese-induced parkinsonism may present with distinct clinical characteristics compared to idiopathic forms.
- Normal fluorodopa PET scan results in the context of specific clinical signs could indicate manganese toxicity.
- Further research into differentiating neurotoxic parkinsonism from idiopathic forms is warranted.