A Rare Cause of Parkinsonism—Manganese Toxicity

Abstract

A 43-year-old male presented with six months history of gradual onset and progressive bradykinesia, tremors of upper limbs and walking difficulty in the form of imbalance and short shuffling gait. He also had slurring of speech with hypophonia. Neurological examination revealed slow broken saccades, rigidity with cogwheeling, bradykinesia and short shuffling, festinant gait. He had action and postural tremors of upper limbs. Pull test was positive. Thus, a diagnosis of Young onset Parkinsonism was considered. Occupational history revealed that he worked in blast furnace of a steel plant since past 14 years. He was evaluated with magnetic resonance imaging (MRI) Brain which showed symmetrical hyperintensities involving basal ganglia and subcortical white matter in T2 weighted images. T1 weighted images showed evidence of basal ganglia hyperintensities probably related to mineral deposition. KF Ring, S. ceruloplasmin, Liver function tests and Ultrasound abdomen was normal. Peripheral smear did not show any acanthocytes. Renal function and thyroid function tests were normal. Anti-thyroid antibodies were normal. Cerebrospinal fluid (CSF) was normal. In view of occupational exposure and clinical features, a possibility of Manganese toxicity was strongly considered. Serum Manganese was done which was elevated (Twice of upper limit of normal). Patient was started on symptomatic medications such as levodopa and trihexyphenidyl. He had stopped working which eliminated occupational exposure to manganese. His parkinsonism gradually started to improve over three months period of follow up. Plan is to repeat the serum manganese level after 3 months. Conclusion: Occupational history of manganese exposure is very important in cases of Parkinsonism. Early removal from the work environment can lead to improvement of symptoms and prevent permanent neurological deficits.

Keywords: Parkinsonism, idiopathic Parkinsons disease (IPD), toxicity, manganism

Cite this Article

Praveen Kumar Yadav, Priyanka Roy. A Rare Cause of Parkinsonism—Manganese Toxicity. Research and Reviews: Journal of Neuroscience. 2019; 9(1): 29–32p.