Manganism

Manganism (also known as acquired hypermanganesemia) is the clinical syndrome resulting from acute or chronic overexposure to the transition metal manganese, one of the essential trace elements. It primarily manifests as parkinsonism and is frequently clinically, radiologically and histopathologically indistinguishable from classic idiopathic Parkinson disease .

Clinical presentation

• typical parkinsonism
  • rigidity
  • bradykinesia
  • rest tremor
  • postural instability

Pathology

Manganese is an essential trace element with a vital role in the synthesis of several key enzymes, vitamin B complex and vitamin C, as well as several other substrates. However certain occupations, especially welders, can be exposed to toxic levels of the element.

Radiographic features

MRI

• T1: hyperintense signal in the globus pallidi bilaterally
• T2: normal signal in the globus pallidi

The degree of T1 hyperintensity can be quantified as the pallidal index (PI). The pallidal index approximately correlates to the lifetime exposure and level of serum manganese .