title: The enigma of parkinsonism in chronic borderline mercury intoxication, resolved by challenge with penicillamine.
abstract: A 47 year old female dentist suffered from hemiparkinsonism which had started eighteen months earlier and was manifested mainly by resting tremor and cogwheel rigidity. A baseline quantitative urinary mercury excretion was 46 micrograms/day. The patient was treated with chelating agent d-penicillamine for a week. Chelation therapy resulted in clinical improvement of parkinsonism and in dynamic changes in daily urinary mercury excretion with a prompt increase to 79 micrograms/day, a subsequent decline followed by increase in the mercury urinary excretion. After a week chelation therapy was stopped. During a follow-up period of five years, the neurological status remained unchanged after the initial penicillamine-induced improvement. This case may be evidence, therefore, of a rare clinical variant of elemental mercury intoxication associated with parkinsonism, in the absence of most classical neuropsychiatric signs of chronic mercurialism.
authors.affiliation: Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Finkelstein
authors.forename: J
authors.initials: J
authors.lastname: Vardi
authors.forename: M M
authors.initials: MM
authors.lastname: Kesten
authors.forename: I
authors.initials: I
authors.lastname: Hod
mesh_terms: D002614:Chelating Agents / Q000627:therapeutic use*; D003815:Dentists; D005260:Female; D006801:Humans; D008628:Mercury / Q000009:adverse effects / Q000652:urine; D008630:Mercury Poisoning / Q000188:drug therapy* / Q000652:urine; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced / Q000188:drug therapy*; D010302:Parkinson Disease, Secondary / Q000139:chemically induced / Q000188:drug therapy*; D010396:Penicillamine / Q000627:therapeutic use*
chemical_list: D002614:Chelating Agents; D008628:Mercury; D010396:Penicillamine