title: Neurologic disorders due to brain manganese deposition in a jaundiced patient receiving long-term parenteral nutrition.
abstract: BACKGROUND
  Neurologic and radiologic disorders have been reported in patients receiving long-term parenteral nutrition (PN). On the basis of elevated serum manganese levels, some of these abnormalities have been attributed to manganese intoxication. Alterations of the basal ganglia signal intensity on T1-weighted magnetic resonance images (MRIs) have been previously reported, but the precise nature of these alterations remains controversial although the deposition of manganese has been suggested in patients with chronic hepatic encephalopathy due to liver failure.
  
  
  METHODS
  We report the case of a patient who was receiving PN and exhibited a chronic cholestasis. Neurologic disorders appeared after several months of PN, when a hypersignal in the basal ganglia and white matter was found on T1-weighted MRIs of the brain in association with elevated serum and manganese levels.
  
  
  RESULTS
  Elevated autopsic concentrations of manganese were found in the radiologic abnormal cerebral areas.
  
  
  CONCLUSIONS
  Our observation is the first demonstration of a relationship between high intracerebral manganese levels, radiologic abnormalities, and neurologic disorders during long-term PN. Moreover, serum manganese levels are not a good indicator of cerebral levels. In fact, in our patient, serum manganese levels returned to normal, whereas those of cerebral manganese remained increased.
authors.affiliation: GBPDN, Hôpital Charles Nicolle, Rouen, France.
authors.forename: G
authors.initials: G
authors.lastname: Alves
authors.forename: J
authors.initials: J
authors.lastname: Thiebot
authors.forename: A
authors.initials: A
authors.lastname: Tracqui
authors.forename: T
authors.initials: T
authors.lastname: Delangre
authors.forename: C
authors.initials: C
authors.lastname: Guedon
authors.forename: E
authors.initials: E
authors.lastname: Lerebours
mesh_terms: D001921:Brain / Q000378:metabolism / Q000473:pathology*; D001923:Brain Chemistry; D002767:Cholecystostomy; D002779:Cholestasis / Q000628:therapy*; D002908:Chronic Disease; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008345:Manganese / Q000008:administration & dosage / Q000097:blood; D020149:Manganese Poisoning; D008875:Middle Aged; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology; D010288:Parenteral Nutrition / Q000009:adverse effects*
chemical_list: D008345:Manganese