Hyperintense Basal Ganglia on T1-Weighted Magnetic Resonance Images following Postoperative Parenteral Nutrition in a Pancreatoduodenectomized Patient

Iwase, Kazuhiro; Kondoh, Haruhiko; Higaki, Jitsuo; Tanaka, Yasushi; Yoshikawa, Masaharu; Hori, Shingo; Osuga, Keigo; Kamiike, Wataru

doi:10.1159/000018830

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…An increased T1-weighted (the time associated with the return of longitudinal magnetization to its equilibrium condition is termed the spin lattice relaxation time, T1, and reflects the strength and nature of magnetic interactions between the spins and their atomic neighborhood). Mn signal in the globus pallidus area has been found among workers occupationally exposed to Mn (Dietz et al 2001;Jiang et al, 2006a;Kim et al, 1999a;Lucchini et al, 2000;Nelson et al, 1993), in patients receiving long-term total parenteral nutrition (Alves et al, 1997;Ejima et al, 1992;Fell et al, 1996;Fredstrom et al, 1995;Iwase et al,2000;Nagatomo et al, 1999;Quaghebeur et al, 1996) and in clinical cases of hepatic failure (Butterworth et al, 1995;Chetri et al, 2003;Hauser et al, 1994;Hazell et al 1999;McKinney et al, 2004;Spahr et al, 2002). Kim and his colleagues have reported that a welder with more than 10 years of Mn exposure whose clinical manifestations included a masked face, asymmetric resting tremor and bradykinesia had symmetrical high signal intensities in the globus pallidus on the T1-weighted image.…”

Section: B Search For Biomarker Of Mn Exposurementioning

confidence: 99%

Manganese: Recent advances in understanding its transport and neurotoxicity

Aschner

Guilarte

Schneider

et al. 2007

Toxicology and Applied Pharmacology

560

398

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The present review is based on presentations from the meeting of the Society of Toxicology in San Diego, CA (March 2006). It addresses recent developments in the understanding of the transport of manganese (Mn) into the central nervous system (CNS), as well as brain imaging and neurocognitive studies in non-human primates aimed at improving our understanding of the mechanisms of Mn neurotoxicity. Finally, we discuss potential therapeutic modalities for treating Mn intoxication in humans.

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Section: B Search For Biomarker Of Mn Exposurementioning

confidence: 99%

Manganese: Recent advances in understanding its transport and neurotoxicity

Aschner

Guilarte

Schneider

et al. 2007

Toxicology and Applied Pharmacology

560

398

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“…One adult patient received TPN for 30 days postoperatively (Iwase et al 2000). On postoperative day 49, the T1-weighted MRI demonstrated bilateral and symmetrical hyperintense lesions in the globus pallidus.…”

Section: The Clearance Of Excessive Manganesementioning

confidence: 99%

Parkinsonism due to Manganism in a Welder

Sadek

Rauch

Schulz³

2003

Int J Toxicol

111

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A 33-year-old right-handed male presented complaining of a 2-year history of progressive cognitive slowing, rigidity, tremors, slowing of movements, and gait instability leading to falls. On examination, he had a Mini-Mental Status Examination (MMSE) score of 29, slowed saccadic eye pursuit, hypomimia, cogwheel rigidity, a 3- to 4-Hz tremor, and a "cock-walk" gait. His symptoms and signs were similar to idiopathic Parkinson's disease; however, he was young, inattention and forgetfulness occurred early in the course of the disorder, levodopa was unhelpful, and his gait was atypical. His work up for secondary causes of parkinsonism was negative, except for increased signal intensity on T1-weighted magnetic resonance image (MRI) in the bilateral basal ganglia. Typical etiologies for that finding were ruled-out, which led to further inquiries into the patient's lifestyle. He was a welder, and discussion with his employer revealed that he used a steel-manganese alloy, he often worked in a confined ship's hold, and he did not use a respiratory mask. Because manganese toxicity can produce increased T1-weighted signal intensities in the basal ganglia, the authors tested his serum and urine manganese, and both were elevated. This patient emphasizes the importance of a careful occupational history in persons presenting with atypical manifestations of a neurodegenerative disorder. It also lends support to the hypothesis that welding can produce enough exposure to manganese to produce neurologic impairment.

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“…An increased T1-weighted Mn signal in the globus pallidus area has been found among workers occupationally exposed to Mn (Dietz et al, 2001;Kim et al, 1999b;Lucchini et al, 2000;Nelson et al, 1993), in patients receiving long-term total parenteral nutrition (Alves et al, 1997;Ejima et al, 1992;Fell et al, 1996;Fredstrom et al, 1995;Iwase et al, 2000;Komaki et al, 1999;Nagatomo et al, 1999;Quaghebeur et al, 1996), and in clinical cases reported with hepatic failure (Butterworth et al, 1995;Chetri and Choudhuri, 2003;Hauser et al, 1994;Hazell and Butterworth, 1999;McKinney et al, 2004;Spahr et al, 2002). While in animal models the MRI intensity has been linked to external Mn exposure (Eriksson et al, 1992;Kim et al, 1999a;Misselwitz et al, 1995;Newland et al, 1989a,b;Shinotoh et al, 1995), the question as to how the change in MRI signals in humans is associated with external exposure conditions and whether this consequentially leads to alternations of the internal Mn exposure indices or the fluctuation in blood chemistry remains elusive.…”

Section: Introductionmentioning

confidence: 98%

Brain magnetic resonance imaging and manganese concentrations in red blood cells of smelting workers: Search for biomarkers of manganese exposure

Jiang¹,

Zheng²,

Лонг³

et al. 2007

NeuroToxicology

127

128

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The MRI technique has been used in diagnosis of manganism in humans and non-human primates. This cross-sectional study was designed to explore whether the pallidal signal intensity in T1-weighted MRI correlated with Mn levels in the blood compartment among Mn-exposed workers and to understand to what extent the MRI signal could reflect Mn exposure. A group of 18 randomly selected male Mn-exposed workers of which 13 were smelting workers with high exposure (mean of airborne Mn in work place: 1.26 mg/m 3 ; range: 0.31-2.93 mg/m 3 ), and 5 power distribution control workers with low exposure (0.66 mg/m 3 and 0.23-0.77 mg/m 3 ) from a ferroalloy factory, and another group of 9 male subjects as controls from a non-smelting factory who were office or cafeteria workers (0.01 mg/m 3 and 0-0.03 mg/m 3 ) were recruited for neurological tests, MRI examination, and analysis of Mn in whole blood (MnB), plasma (MnP) or red blood cells (MnRBC). No clinical symptoms and signs of manganism were observed among these workers. MRI data showed average increases of 7.4% (p < 0.05) and 16.1% (p < 0.01) in pallidal index (PI) among low-and high-exposed workers, respectively, as compared to controls. Fourteen out of 18 Mn-exposed workers (78%) had intensified PI values, while this proportion was even higher (85%) among the high Mn-exposed workers. Among exposed workers, the PI values were significantly associated with MnRBC (r = 0.55, p = 0.02). Our data suggest that the workers exposed to airborne Mn, but without clinical symptoms, display an exposure-related, intensified MRI signal. The MRI, as well as MnRBC, may be useful in early diagnosis of Mn exposure.

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Hyperintense Basal Ganglia on T1-Weighted Magnetic Resonance Images following Postoperative Parenteral Nutrition in a Pancreatoduodenectomized Patient

Cited by 8 publications

References 27 publications

Manganese: Recent advances in understanding its transport and neurotoxicity

Manganese: Recent advances in understanding its transport and neurotoxicity

Parkinsonism due to Manganism in a Welder

Brain magnetic resonance imaging and manganese concentrations in red blood cells of smelting workers: Search for biomarkers of manganese exposure

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