J Korean Neurol Assoc.  1998 Jun;16(3):336-340.

Three Cases of Manganese Induced Parkinsonism: Differences from Idiopathic Parkinsonism

• Kim JW
• Kim Y
• Cheong HK
• Lee AY
• Ito K

Abstract

Manganese (Mn) intoxication is known to induce parkinsonism. Mn-induced parkinsonism preferentially affects the globus pallidus in contrast to idiopathic parkinsonism where the degeneration predominantly involves the nigral pars compacta. We present three patients who had been occupationally exposed to Mn and developed parkinsonism, and one patient who had been exposed to long-term Mn and was proven to have idiopathic parkinsonism. All the manganism patients had a particular propensity to fall in a backward gait and a prominent postural instability compared with the severity of other parkinsonian features. Case 1 also showed a cock walk and dystonic features, quite characteristic findings of manganism. The rigidity, another important parkinsonian sign, was not found in all three manganism patients. There was no sustained therapeutic response to levodopa. A [18F]6-fluoro-L-dopa (6FD) PET scan performed in case 1 was normal in contrast to a reduced uptake in the striatum of the patient with idiopathic parkinsonism. These cases indicate that Mn-induced parkinsonism can be differentiated from idiopathic parkinsonism in that the former has unique clinical features and a normal 6FD PET scan.

Keyword

manganese; parkinsonism; PET

MeSH Terms

Gait
Globus Pallidus
Humans
Levodopa
Manganese*
Occupations
Parkinsonian Disorders*
Positron-Emission Tomography
Levodopa
Manganese