Basal ganglial signal intensity alterations: reversal after discontinuation of parenteral manganese administration.

Abstract

The authors describe magnetic resonance (MR) imaging findings in a patient receiving long-term total parenteral nutrition (TPN) therapy in whom parenteral manganese administration was experimentally discontinued. MR imaging performed while the patient was receiving standard TPN solution demonstrated marked hyperintensity of the globi pallidi on T1-weighted images. Following cessation of parenteral manganese administration for 1 year, repeat MR imaging demonstrated regression of the abnormal signal intensity.

Contribution of metals to brain MR signal intensity: review articles

“…Regardless of the administration route of MnCl 2 , an increasing signal intensity on MRI is observed in the caudate nucleus, globus pallidus, substantia nigra, ventromedial hypothalamus, and pituitary gland [23]. Even in man, a hyperintense globus pallidus was found in patients receiving long-term total parenteral nutrition therapy that included manganese [24] and in workers exposed to manganese [25][26][27], with these hyperintensities diminishing after cessation of the manganese exposure [25,28,29]. Intravenous administration or inhalation of manganese causes manganese deposition in the brain, but the oral intake of manganese rarely results in manganese deposition.…”

Hiperintensidade de sinal em T1 dos núcleos da base: relato de caso na encefalopatia portal sistêmica esquistossomótica

“…A hipótese atualmente mais aceita, que justifique a elevada intensidade de sinal encontrada nos núcleos da base, é a deposição de Mn [21][22][23][24] . O Mn é metal de transição paramagnética com cinco elétrons não pareados com grande momento magnético capaz de promover encurtamento de T1 no exame de RM.…”

“…Existem relatos de desaparecimento das alterações de sinal após transplante hepático 3 , após suspensão da suplementação de Mn ou da dieta parenteral [36][37][38] . Recente relato de completo desaparecimento dos achados à RM é feito por Matsumoto e col. 12 , após embolização terapêutica de shunt venoso porto-sistêmico intra-hepático.…”

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“…The final publication is available at http://dx.doi.org/10.1023/A:1020636809063 Further evidence suggesting that MR images result from manganese deposition is provided by observations in patients receiving long term parenteral nutrition where typical pallidal i mages disappeared after cessation of manganese supplementation (Mirowitz et al, 1991;Mirowitz et al, 1992). Prolonged inhalation of manganese dusts in miners produces similar MR images (Nelson et al, 1993); furthermore exposure of monkeys to manganese administered either by inhalation or intravenously results in selective pallidal hyperintensities on MR imaging (Shinotoh et al, 1995).…”