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Movement disorders and neuropathies: overlaps and mimics in clinical practice. J Neurol 2022; 269:4646-4662. [PMID: 35657406 DOI: 10.1007/s00415-022-11200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Movement disorders as well as peripheral neuropathies are extremely frequent in the general population; therefore, it is not uncommon to encounter patients with both these conditions. Often, the coexistence is coincidental, due to the high incidence of common causes of peripheral neuropathy, such as diabetes and other age-related disorders, as well as of Parkinson disease (PD), which has a typical late onset. Nonetheless, there is broad evidence that PD patients may commonly develop a sensory and/or autonomic polyneuropathy, triggered by intrinsic and/or extrinsic mechanisms. Similarly, some peripheral neuropathies may develop some movement disorders in the long run, such as tremor, and rarely dystonia and myoclonus, suggesting that central mechanisms may ensue in the pathogenesis of these diseases. Although rare, several acquired or hereditary causes may be responsible for the combination of movement and peripheral nerve disorders as a unique entity, some of which are potentially treatable, including paraneoplastic, autoimmune and nutritional aetiologies. Finally, genetic causes should be pursued in case of positive family history, young onset or multisystemic involvement, and examined for neuroacanthocytosis, spinocerebellar ataxias, mitochondrial disorders and less common causes of adult-onset cerebellar ataxias and spastic paraparesis. Deep phenotyping in terms of neurological and general examination, as well as laboratory tests, neuroimaging, neurophysiology, and next-generation genetic analysis, may guide the clinician toward the correct diagnosis and management.
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Liu Y, Rolle-McFarland D, Mostafaei F, Zhou Y, Li Y, Zheng W, Wells E, Nie LH. In vivo neutron activation analysis of bone manganese in workers. Physiol Meas 2018; 39:035003. [PMID: 29328060 DOI: 10.1088/1361-6579/aaa749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Manganese (Mn) is a neurotoxin. However, the impact of elevated, chronic Mn exposure is not well understood, partially due to the lack of a cumulative exposure biomarker. To address this gap, our group developed a compact in vivo neutron activation analysis (IVNAA) system to quantify Mn concentration in bone (MnBn). APPROACH In this study, we used this system and determined MnBn among male Chinese workers and compared results to their blood Mn (MnB), a measure of recent exposure, and the years of employment, a measure of cumulative exposure. A cross-sectional study was conducted with 30 ferroalloy smelters (exposed) and 30 general manufacturing workers (controls). MnBn was assessed using IVNAA, MnB was measured with inductively coupled plasma mass spectrometry, and occupational history and demographics were obtained via questionnaire. Mn-doped phantoms were used to generate a calibration curve; spectra from these phantoms were consistent with in vivo spectra. MAIN RESULTS The median (interquartile range (IQR)) values for Mn biomarkers were 2.7 µg g-1 (7.2) for MnBn and 14.1 µg l-1 (4.0) for MnB. In regression models adjusted for age and education, the natural log transformed MnBn (ln(MnBn)) was significantly associated with the exposed/control status (β = 0.44, p = 0.047) and years of employment (β = 0.05, p = 0.002), but not with natural log transformed MnB (ln(MnB)) (β = 0.54, p = 0.188). SIGNIFICANCE Our results support the use of IVNAA to quantify MnBn and the use of MnBn as a biomarker of cumulative Mn exposure.
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Affiliation(s)
- Yingzi Liu
- School of Health Sciences, Purdue University, West Lafayette, IN 47906, United States of America. Willis-Knighton Cancer Center, Shreveport, LA 71105, United States of America
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Occupational neurotoxic diseases in taiwan. Saf Health Work 2012; 3:257-67. [PMID: 23251841 PMCID: PMC3521924 DOI: 10.5491/shaw.2012.3.4.257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 11/26/2022] Open
Abstract
Occupational neurotoxic diseases have become increasingly common in Taiwan due to industrialization. Over the past 40 years, Taiwan has transformed from an agricultural society to an industrial society. The most common neurotoxic diseases also changed from organophosphate poisoning to heavy metal intoxication, and then to organic solvent and semiconductor agent poisoning. The nervous system is particularly vulnerable to toxic agents because of its high metabolic rate. Neurological manifestations may be transient or permanent, and may range from cognitive dysfunction, cerebellar ataxia, Parkinsonism, sensorimotor neuropathy and autonomic dysfunction to neuromuscular junction disorders. This study attempts to provide a review of the major outbreaks of occupational neurotoxins from 1968 to 2012. A total of 16 occupational neurotoxins, including organophosphates, toxic gases, heavy metals, organic solvents, and other toxic chemicals, were reviewed. Peer-reviewed articles related to the electrophysiology, neuroimaging, treatment and long-term follow up of these neurotoxic diseases were also obtained. The heavy metals involved consisted of lead, manganese, organic tin, mercury, arsenic, and thallium. The organic solvents included n-hexane, toluene, mixed solvents and carbon disulfide. Toxic gases such as carbon monoxide, and hydrogen sulfide were also included, along with toxic chemicals including polychlorinated biphenyls, tetramethylammonium hydroxide, organophosphates, and dimethylamine borane. In addition we attempted to correlate these events to the timeline of industrial development in Taiwan. By researching this topic, the hope is that it may help other developing countries to improve industrial hygiene and promote occupational safety and health care during the process of industrialization.
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Herynek V, Wagnerová D, Hejlová I, Dezortová M, Hájek M. Changes in the brain during long-term follow-up after liver transplantation. J Magn Reson Imaging 2012; 35:1332-7. [DOI: 10.1002/jmri.23599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/29/2011] [Indexed: 12/18/2022] Open
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Abstract
Metals such as iron and copper are critical to living organisms, whereas other metals such as lead and arsenic have no known biologic role. Any metals in large amounts may cause toxicity. Many metals cause pervasive systemic effects involving the nervous system, which can be subtle in some cases. Although challenging, the diagnosis and treatment of metal poisoning can be made based on history, physical examination, and the proper use of metal testing. This article focuses on the use, and misuse, of chelation in the diagnosis and management of metal intoxication.
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Zheng W, Fu SX, Dydak U, Cowan DM. Biomarkers of manganese intoxication. Neurotoxicology 2010; 32:1-8. [PMID: 20946915 DOI: 10.1016/j.neuro.2010.10.002] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/04/2010] [Accepted: 10/04/2010] [Indexed: 01/30/2023]
Abstract
Manganese (Mn), upon absorption, is primarily sequestered in tissue and intracellular compartments. For this reason, blood Mn concentration does not always accurately reflect Mn concentration in the targeted tissue, particularly in the brain. The discrepancy between Mn concentrations in tissue or intracellular components means that blood Mn is a poor biomarker of Mn exposure or toxicity under many conditions and that other biomarkers must be established. For group comparisons of active workers, blood Mn has some utility for distinguishing exposed from unexposed subjects, although the large variability in mean values renders it insensitive for discriminating one individual from the rest of the study population. Mn exposure is known to alter iron (Fe) homeostasis. The Mn/Fe ratio (MIR) in plasma or erythrocytes reflects not only steady-state concentrations of Mn or Fe in tested individuals, but also a biological response (altered Fe homeostasis) to Mn exposure. Recent human studies support the potential value for using MIR to distinguish individuals with Mn exposure. Additionally, magnetic resonance imaging (MRI), in combination with noninvasive assessment of γ-aminobutyric acid (GABA) by magnetic resonance spectroscopy (MRS), provides convincing evidence of Mn exposure, even without clinical symptoms of Mn intoxication. For subjects with long-term, low-dose Mn exposure or for those exposed in the past but not the present, neither blood Mn nor MRI provides a confident distinction for Mn exposure or intoxication. While plasma or erythrocyte MIR is more likely a sensitive measure, the cut-off values for MIR among the general population need to be further tested and established. Considering the large accumulation of Mn in bone, developing an X-ray fluorescence spectroscopy or neutron-based spectroscopy method may create yet another novel non-invasive tool for assessing Mn exposure and toxicity.
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Affiliation(s)
- Wei Zheng
- School of Health Sciences, Purdue University, West Lafayette, IN 47907, USA.
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El Muhtaseb MSH, Duncan A, Talwar DK, O'Reilly DSJ, McKee RF, Anderson JH, Finlay IG. Assessment of dietary intake and trace element status in patients with ileal pouch-anal anastomosis. Dis Colon Rectum 2007; 50:1553-7. [PMID: 17701072 DOI: 10.1007/s10350-007-9003-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Panproctocolectomy and ileal pouch-anal anastomosis is the operation of choice for patients with ulcerative colitis and familial polyposis. The long-term nutritional consequences after pouch surgery are unknown. We have assessed the nutritional status of the essential trace elements-zinc, copper, manganese, and selenium-in patients several years (median, 10 (range, 2-15) years) after surgery. METHODS Fifty-five patients with uncomplicated ileal pouch-anal anastomosis and 46 healthy control subjects were studied. A dietary assessment of trace element intake was undertaken by using a semiquantitative food frequency questionnaire. The patients' trace elements status for zinc, copper, manganese, and selenium was assessed by measuring their concentrations in blood. RESULTS The dietary intake of individual trace elements was similar in both groups (all P values > 0.4). There was no significant difference in the concentrations of plasma copper, zinc, and selenium between patients and healthy control subjects (all P values > 0.07). The concentration of whole blood manganese was significantly higher (P = 0.004) in patients (median, 178.5 nmol/l; range, 59-478 nmol/l) compared with healthy control subjects (median, 140 nmol/l; range, 53-267 nmol/l). Four (7 percent) patients had manganese concentrations more than three standard deviations of the mean of control group (>255 nmol/l). CONCLUSIONS This study shows that patients who have had uncomplicated pouch surgery have a normal dietary intake of trace elements and do not develop deficiencies in copper, zinc, manganese, and selenium. However, these patients may be at increased risk of manganese toxicity.
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Affiliation(s)
- Mohammad Sami H El Muhtaseb
- Department of Coloproctology, Lister Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, United Kingdom.
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Kenangil G, Ertan S, Sayilir I, Ozekmekçi S. Progressive motor syndrome in a welder with pallidal T1 hyperintensity on MRI: A two-year follow-up. Mov Disord 2006; 21:2197-200. [PMID: 17013920 DOI: 10.1002/mds.21119] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Chronic exposure to manganese (Mn) fume during welding may lead to mainly extrapyramidal syndrome that is resistant to treatment. We present a 32-year-old patient who developed severe postural instability, Parkinsonism, dystonia, and pyramidal signs in the 10th year of welding. The neurological condition of the patient worsened markedly in the following 3 years, resulting in severe disability rendering him to be assisted in all his daily activities and he did not benefit from any dopaminergic agent. T1 sequences of the MRI of the brain showed pallidal hyperintensity symmetrically. Welders in our country often protect their eyes but ignore to use tools that protect them from inhalation of the fume. Since chronic Mn toxicity may cause serious disability and irreversible neurological disturbances, we strongly believe that it is necessary to inform welders and their employers about this potential hazard.
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Affiliation(s)
- Gülay Kenangil
- Department of Neurology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
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9
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Abstract
Manganese and its inorganic compounds are widely used in many industries and have been accepted as occupational neurotoxins that have caused a distinct and disabling clinical entity, manganism, in several types of work, notably where exposure is by way of dust. There is inconclusive and inconsistent evidence that, in these occupations, subclinical neurological effects, detectable only by neurobehavioural studies, may be caused by low doses. This has prompted a re-evaluation of occupational exposure limits. Some countries, including the UK, already demand much higher levels of protection against exposure than 5 years ago. Welding is the most common source of occupational exposure as manganese is an essential component of steel and so its compounds are inevitable components of fume emitted from steel welding processes. There it is found in respirable particles, often as complex oxides (spinels), sometimes within a core protected by a silicon oxide shell - as distinct from the much simpler form of particle formed by disintegration in processes such as mining and ore milling where manganism has been diagnosed convincingly. Millions of workers are at risk of exposure to manganese-containing compounds in fumes from electric arc welding of steel. In recent years it has been asserted that neurological and neurobehavioural disorders may develop consequent to exposure to steel welding fumes and that employment as a welder is associated with the unusually early onset of Parkinson's disease. Causal relationships have been postulated. Welders have been recorded as having been exposed to high levels of manganese-containing fume, especially where they have worked in confined, unventilated spaces, although this appears from limited data to be the exception rather than the rule. Even then the dose received is generally less than in mining or ore crushing. When care is taken to exclude exposures from hardfacing and burning and cutting arc processes, where manganese may form a high percentage of the fume, manganese compounds usually form a relatively low percentage of the composition of welding fume particles, <2.0%, much outweighed by iron. Although these manganese-compound-containing welding fume particles are insoluble in water, the manganese compounds in particles that are retained in the alveoli may be absorbed, at least in part. Manganese concentrations in biological material samples in some exposed groups reflect this relative to unexposed workers. Some of the transfer systems for absorption and transport, including across the blood-brain barrier, are used in competition with iron which is present in abundance in welding fume. This may reduce absorption of manganese in welders and thus reduce the opportunity for sufficient doses to cause neurotoxicological consequences. Scrutiny of the literature covering the last 40 years has revealed only five cases that meet sufficient criteria for manganism to just cross the diagnostic threshold, and even then they carry a degree of doubt with them. This low incidence alone gives notice that welders have not been and are not at high risk of clinically apparent damage from exposure to manganese. If this needs to be further emphasised, there is the fact that the literature contains no confirmed cases of manganism in welders. Assertions of abnormal results in neurobehavioural studies of welders have raised the possibility of there being a subclinical form of manganism with loss of fine motor control as one of its features. While observations of such changes in workers in other industries have caused regulators in some countries to apply more stringent controls of exposure, as yet the results lack convincing consistency and there is no indication of any dose-effect relationship. If welding fume can have these motor effects it would be a heavy and perhaps career-ending blow to those affected. It would not be prudent to dismiss the warnings sounded by the results of studies of welders, no matter how flawed these investigations are, but wiser and better to act with vigour to reduce exposure and monitor the effectiveness of this additional protection whilst conducting high quality research to allow sound conclusions to be drawn as to whether there actually is a subclinical disorder. Idiopathic Parkinson's disease is a common disorder affecting 1-2% of those in the general population aged >65 years. It has been suggested, on flawed and contested evidence, not that welding causes the disease but rather that employment as a welder carries with it the risk of developing this disease at a younger age than if that trade had not been followed. Manganese in welding fume has been nominated as the neurotoxin. This may be biologically feasible if manganese destroys insufficient receptor cells to produce clinical manganism but sufficient to enhance the effects of a reduced supply of dopamine to give the manifestations of already developing idiopathic Parkinson's disease earlier in the course of destruction of the substantia nigra than if all receptors were intact.
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Jiang Y, Zheng W, Long L, Zhao W, Li X, Mo X, Lu J, Fu X, Li W, Liu S, Long Q, Huang J, Pira E. Brain magnetic resonance imaging and manganese concentrations in red blood cells of smelting workers: search for biomarkers of manganese exposure. Neurotoxicology 2006; 28:126-35. [PMID: 16978697 PMCID: PMC3983995 DOI: 10.1016/j.neuro.2006.08.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 08/10/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
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/m3; range: 0.31-2.93 mg/m3), and 5 power distribution control workers with low exposure (0.66 mg/m3 and 0.23-0.77 mg/m3) 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/m3 and 0-0.03 mg/m3) 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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Affiliation(s)
- Yueming Jiang
- Department of Occupational Health and Toxicology, Guangxi Medical University, Nanning 530021, China
| | - Wei Zheng
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, CIVL-1163D, West Lafayette, IN 47907, USA
- Corresponding author. Tel.: +1 765 496 6447; fax: +1 765 496 1377. (W. Zheng)
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Weijia Zhao
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xiangrong Li
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xuean Mo
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jipei Lu
- Department of Occupational Health and Toxicology, Guangxi Medical University, Nanning 530021, China
| | - Xue Fu
- Department of Occupational Health and Toxicology, Guangxi Medical University, Nanning 530021, China
| | - Wenmei Li
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Shouting Liu
- Guangxi Center for Analysis and Test Research, Nanning 530021, China
| | - Quanyong Long
- Worker’s Hospital of Guangxi Bayi Ferroalloy Company, Laibin 546102, China
| | - Jinli Huang
- Worker’s Hospital of Guangxi Bayi Ferroalloy Company, Laibin 546102, China
| | - Enrico Pira
- Department of Traumatology, Orthopaedics and Occupational Health, University of Turin, Turin 10126, Italy
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Racette BA, Antenor JA, McGee-Minnich L, Moerlein SM, Videen TO, Kotagal V, Perlmutter JS. [18F]FDOPA PET and clinical features in parkinsonism due to manganism. Mov Disord 2005; 20:492-496. [PMID: 15648057 DOI: 10.1002/mds.20381] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Manganese exposure reportedly causes a clinically and pathophysiologically distinct syndrome from idiopathic Parkinson's disease (PD). We describe the clinical features and results of positron emission tomography with 6-[18F]fluorodopa ([18F]FDOPA PET) of a patient with parkinsonism occurring in the setting of elevated blood manganese. The patient developed parkinsonism associated with elevated serum manganese from hepatic dysfunction. [18F]FDOPA PET demonstrated relatively symmetric and severely reduced [18F]FDOPA levels in the posterior putamen compared to controls. The globus pallidum interna had increased signal on T1-weighted magnetic resonance imaging (MRI) images. We conclude that elevated manganese exposure may be associated with reduced striatal [18F]FDOPA uptake, and MRI may reveal selective abnormality within the internal segment of the pallidum. This case suggests that the clinical and pathophysiological features of manganese-associated parkinsonism may overlap with that of PD.
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Affiliation(s)
- Brad A Racette
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jo Ann Antenor
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lori McGee-Minnich
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen M Moerlein
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tom O Videen
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Vikas Kotagal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Affiliation(s)
- Anne Krantz
- Section of Clinical Toxicology, John H. Stroger, Jr. Hospital of Cook County, University of Illinois at Chicago School of Public Health, USA
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Herrero Hernandez E, Valentini MC, Discalzi G. T1-weighted hyperintensity in basal ganglia at brain magnetic resonance imaging: are different pathologies sharing a common mechanism? Neurotoxicology 2002; 23:669-74. [PMID: 12520756 DOI: 10.1016/s0161-813x(02)00016-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Basal ganglia bilateral symmetric hyperintensity in T1-weighted sequences at magnetic resonance imaging (MRI) is recognized to be due to the presence of manganese deposits. This abnormal finding has been reported in occupational exposures, liver cirrhosis and total parenteral nutrition with unbalanced solutions. However, the same imaging is often observed "by chance" in brain MRIs of patients not belonging to these groups. In order to better understand which are the clinical conditions coexisting with such findings, we decided to study systematically patients which showed this kind of imaging, focusing on their manganese and iron status, as it is known that these two metals have similar properties and that iron-deficiency can competitively increase manganese absorption. The 20 patients studied underwent clinical evaluation and the following laboratory tests: whole blood iron and manganese, hemoglobin, plasma iron, transferrin and ferritin. The neuroradiologic evaluation was integrated by pallidal index calculation, in order to provide a semi-quantitative esteem of the hyperintensity. The patients could be classified into four subgroups: Parkinsonism, anemia, cirrhosis, central nervous system tumors. In 18 out of 20 cases, we found abnormalities in iron and/or manganese-related values. Particularly, iron-deficiency seems to be frequent among patients showing brain MRI abnormalities compatible with manganese deposits in basal ganglia. This observation suggests that iron-deficiency could be an important risk factor for manganese-induced neurotoxicity and should, therefore, be accurately considered and treated.
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Affiliation(s)
- Elena Herrero Hernandez
- Department of Traumatology, Orthopaedics and Occupational Health, Occupational Health Section, CTO Hospital, University of Turin, Via Zuretti 29, 10126 Turin, Italy.
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Santos-Burgoa C, Rios C, Mercado LA, Arechiga-Serrano R, Cano-Valle F, Eden-Wynter RA, Texcalac-Sangrador JL, Villa-Barragan JP, Rodriguez-Agudelo Y, Montes S. Exposure to manganese: health effects on the general population, a pilot study in central Mexico. ENVIRONMENTAL RESEARCH 2001; 85:90-104. [PMID: 11161659 DOI: 10.1006/enrs.2000.4108] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To support a risk assessment of manganese exposure in two communities living within a manganese mining district a cross-sectional study was performed on a sample of the adult population of long-term residents. One community was exposed to a point source from an ore primary refining plant. Manganese is an essential mineral for human life. It is also the fourth in importance for industrial metal making. Data were collected on socioeconomic living conditions, emission sources, environmental media concentrations (air, water, soil, dust, food), respiratory symptomatology, and a neuropsychological examination (Mini-Mental Screening test, the Hooper Visual Organization test, the Ardila-Ostroski, and others). We examined 73 subjects (52 women), most of low socioeconomic status. Environmental air concentrations were 2 to 3 times higher than those in other urban concentrations. Manganese blood concentrations ranged from 7.5 to 88 microg/L, with a median concentration of 15, the upper quartile starting at 20 microg/L; the upper 10% was above 25 microg/L. Lead and manganese were highly correlated; there was an inverse relation to hemoglobin. Reduced levels of plasma lipid peroxidation were associated with blood manganese. Using multivariate logistic regression, we identified B-Mn as increasing the risk of deficient cognitive performance 12 times (Mini-Mental score of less than 17).
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Affiliation(s)
- C Santos-Burgoa
- Instituto de Salud Ambiente y Trabajo, Cerrada del Convento 48-A, Colonia Santa Ursula Xitla, Tlalpan, D.F. c.p. 14420, Mexico.
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15
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Abstract
Manganese is a very hard, brittle metal, which is used to increase the strength of steel alloys. Absorption from the gastrointestinal tract occurs in the divalent and tetravalent forms. Permanganates, which are strong oxidizing agents, have a +7 valence. The principal organomanganese compound is the anti-knock additive, methylcyclopentadienyl manganese tricarbonyl. Manganese is a ubiquitous constituent of the environment comprising about 0.1% of the earth's crust. For the general population, food is the most important source of manganese with daily intake ranging from 2-9 mg Mn. Combustion of gasoline containing methylcyclopentadienyl manganese tricarbonyl releases submicron particles of Mn3O4 that are potentially respirable. Biomagnification of manganese in the food chain probably does not occur. The lungs and gastrointestinal tract absorb some manganese, but the relative amounts absorbed from each site are not known. Homeostatic mechanisms limit the absorption of manganese from the gastrointestinal tract. Elimination of manganese occurs primarily by excretion into the bile. Animal studies indicate that manganese is an essential co-factor for enzymes, such as hexokinase, superoxide dismutase, and xanthine oxidase. However, no case of manganese deficiency in humans has been identified. Manganism is a central nervous system disease first described in the 1800s following exposure to high concentrations of manganese oxides. Manganese madness was the term used to describe the initial psychiatric syndrome (compulsive behavior, emotional lability, hallucinations). More commonly, these workers developed a Parkinson's-like syndrome. Currently, the risks of exposure to low concentrations of manganese in the industrial and in the environmental settings (e.g., methylcyclopentadienyl manganese tricarbonyl in gasoline) are being evaluated with regards to the development of subclinical neuropsychological changes. The American Conference of Governmental and Industrial Hygienists recently lowered the TLV-TWA for manganese compounds and inorganic manganese compounds to 0.2 mg Mn/m3.
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