Parkinsonism Caused by Chronic Usage of Intravenous Potassium Permanganate

Meral, Hasan; Kutukcu, Yasar; Atmaca, Birgül; Özer, Feriha; Hamamcioglu, Kemal

doi:10.1097/01.nrl.0000253089.20746.a8

Cited by 32 publications

(21 citation statements)

References 17 publications

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“…Inhibition of symptoms development was occasionally observed due to complete Mn-containing preparations abstinence [13]. Although in some patients regression of hyperintense changes in lentiform nuclei was observed, it was not correlated with any improvement in clinical condition [15,16]. This observation was confirmed by our own experience.…”

Section: Discussionsupporting

confidence: 64%

MRI brain findings in ephedrone encephalopathy associated with manganese abuse: Single-center perspective

et al. 2014

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SummaryBackgroundManganese (Mn) is a well-known toxic agent causing symptoms of parkinsonism in employees of certain branches of industry. Home production of a psychostimulant ephedrone (methcathinone), involving the use of potassium permanganate, became a new cause of intoxications in Poland.Case ReportThis article presents clinical symptoms, initial brain MRI findings and characteristics of changes observed in follow-up examinations in 4 patients with manganese intoxication associated with intravenous administration of ephedrone. All patients in our case series presented symptoms of parkinsonism. T1-WI MRI revealed high intensity signal in globi pallidi in all patients; hyperintense lesions in midbrain were observed in three patients, while lesions located in cerebellar hemispheres and pituitary gland in just one patient. The reduction of signal intensity in the affected brain structures was observed in follow-up studies, with no significant improvement in clinical symptoms.ConclusionsBrain MRI is helpful in the assessment of distribution as well as dynamics of changes in ephedrone encephalopathy. Regression of signal intensity changes visible in brain MRI is not associated with clinical condition improvement. Although brain MRI findings are not characteristic for ephedrone encephalopathy, they may contribute to diagnosing this condition.

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Section: Discussionsupporting

confidence: 64%

MRI brain findings in ephedrone encephalopathy associated with manganese abuse: Single-center perspective

et al. 2014

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“…Manganese-induced Parkinsonism associated with injected homemade methcathinone has been identified in the literature (De Bie, et al, 2007; Stepens, et al, 2008). This apparently persistent, rapid onset, levodopa resistant Parkinsonism is presumed to result from injecting unreacted KMnO 4 present in the homemade solution that results from an oxidation of ephedrine and potassium permanganate (Stepens, et al, 2008; Sanotsky et al, 2007; Degner, et al, 2000) and is reported as occurring in drug users elsewhere who injected a similar solution of ephedrine, KMnO 4 , vinegar and acetic salicylic acid (Meral, et al, 2007). …”

Section: Discussionmentioning

confidence: 99%

Boltushka: A homemade amphetamine-type stimulant and HIV risk in Odessa, Ukraine

Chintalova-Dallas

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Kitsenko³

et al. 2009

International Journal of Drug Policy

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“…Recently, there have been a number of reports, primarily originating from Eastern European countries and Russia, of young addicts afflicted with an atypical form of parkinsonism (de Bie et al 2007; Meral et al 2007; Sanotsky et al 2007; Selikhova et al 2008; Sikk et al 2007; Stepens et al 2008; Varlibas et al 2009) (Table 1). This form of parkinsonism is the result of intravenous injections of a psychostimulant drug called “ephedrone” or “Russian cocktail,” a drug in which ephedrine is oxidized using potassium permanganate and acetic acid (Sanotsky et al 2007; Stepens et al 2008).…”

Section: Mn-induced Parkinsonism From Human Conditions Not Related Tomentioning

confidence: 99%

Manganese and Parkinson’s Disease: A Critical Review and New Findings

Guilarte

2010

Environ Health Perspect

327

258

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BackgroundExcess accumulation of manganese (Mn) in the brain results in a neurological syndrome with cognitive, psychiatric, and movement abnormalities. The highest concentrations of Mn in the brain are achieved in the basal ganglia, which may precipitate a form of parkinsonism with some clinical features that are similar and some that are different to those in Parkinson’s disease (PD). Recently, scientists have debated the possibility that Mn may have an etiological role in PD or that it may accelerate the expression of PD.ObjectiveThe goal of this review was to examine whether chronic Mn exposure produces dopamine neuron degeneration and PD or whether it has a distinct neuropathology and clinical presentation.Data sourceI reviewed available clinical, neuroimaging, and neuropathological studies in humans and nonhuman primates exposed to Mn or other human conditions that result in elevated brain Mn concentrations.Data extractionHuman and nonhuman primate literature was examined to compare clinical, neuroimaging, and neuropathological changes associated with Mn-induced parkinsonism.Data synthesisClinical, neuroimaging, and neuropathological evidence was used to examine whether Mn-induced parkinsonism involves degeneration of the nigrostriatal dopaminergic system as is the case in PD.ConclusionsThe overwhelming evidence shows that Mn-induced parkinsonism does not involve degeneration of midbrain dopamine neurons and that l-dopa is not an effective therapy. New evidence is presented on a putative mechanism by which Mn may produce movement abnormalities. Confirmation of this hypothesis in humans is essential to make rational decisions about treatment, devise effective therapeutic strategies, and set regulatory guidelines.

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Parkinsonism Caused by Chronic Usage of Intravenous Potassium Permanganate

Abstract: Chronic overexposure to manganese may cause an atypical form of parkinsonism associated with increased T1 signal in the basal ganglia on magnetic resonance imaging.

Cited by 32 publications

References 17 publications

MRI brain findings in ephedrone encephalopathy associated with manganese abuse: Single-center perspective

MRI brain findings in ephedrone encephalopathy associated with manganese abuse: Single-center perspective

Boltushka: A homemade amphetamine-type stimulant and HIV risk in Odessa, Ukraine

Manganese and Parkinson’s Disease: A Critical Review and New Findings

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