BACKGROUND: Neurologic and radiologic disorders have been reported in patients receiving long-term parenteral nutrition (PN). On the basis of elevated serum manganese levels, some of these abnormalities have been attributed to manganese intoxication. Alterations of the basal ganglia signal intensity on T1-weighted magnetic resonance images (MRIs) have been previously reported, but the precise nature of these alterations remains controversial although the deposition of manganese has been suggested in patients with chronic hepatic encephalopathy due to liver failure. METHODS: We report the case of a patient who was receiving PN and exhibited a chronic cholestasis. Neurologic disorders appeared after several months of PN, when a hypersignal in the basal ganglia and white matter was found on T1-weighted MRIs of the brain in association with elevated serum and manganese levels. RESULTS: Elevated autopsic concentrations of manganese were found in the radiologic abnormal cerebral areas. CONCLUSIONS: Our observation is the first demonstration of a relationship between high intracerebral manganese levels, radiologic abnormalities, and neurologic disorders during long-term PN. Moreover, serum manganese levels are not a good indicator of cerebral levels. In fact, in our patient, serum manganese levels returned to normal, whereas those of cerebral manganese remained increased.
BACKGROUND: Neurologic and radiologic disorders have been reported in patients receiving long-term parenteral nutrition (PN). On the basis of elevated serum manganese levels, some of these abnormalities have been attributed to manganese intoxication. Alterations of the basal ganglia signal intensity on T1-weighted magnetic resonance images (MRIs) have been previously reported, but the precise nature of these alterations remains controversial although the deposition of manganese has been suggested in patients with chronic hepatic encephalopathy due to liver failure. METHODS: We report the case of a patient who was receiving PN and exhibited a chronic cholestasis. Neurologic disorders appeared after several months of PN, when a hypersignal in the basal ganglia and white matter was found on T1-weighted MRIs of the brain in association with elevated serum and manganese levels. RESULTS: Elevated autopsic concentrations of manganese were found in the radiologic abnormal cerebral areas. CONCLUSIONS: Our observation is the first demonstration of a relationship between high intracerebral manganese levels, radiologic abnormalities, and neurologic disorders during long-term PN. Moreover, serum manganese levels are not a good indicator of cerebral levels. In fact, in our patient, serum manganese levels returned to normal, whereas those of cerebral manganese remained increased.
Authors: N Kamata; N Oshitani; R Oiso; T Kawachiya; M Inagawa; D Kawashima; M Iimuro; M Sogawa; Y Jinno; K Watanabe; S Nakamura; K Higuchi; T Matsumoto; T Arakawa Journal: Dig Dis Sci Date: 2003-05 Impact factor: 3.199
Authors: Dinamene Santos; Santos Dinamene; M Camila Batoréu; Batoreu M Camila; I Tavares de Almeida; L Davis Randall; M Luísa Mateus; Mateus M Luisa; Vanda Andrade; Andrade Vanda; Ruben Ramos; Ramos Ruben; Edite Torres; Torres Edite; Michael Aschner; Aschner Michael; A P Marreilha dos Santos; A P Marreilha Dos Santos Journal: Toxicology Date: 2013-09-20 Impact factor: 4.221