[Parkinsonism probably induced by manganese].
BACKGROUND
In all cases of young persons with clinical Parkinson s disease it should be suspected that it is secondary to some primary disorder. Therefore a battery of diagnostic tests should be done before classification as idiopathic Parkinson s disease.


METHODS
A 31 year old woman whose only previous illness had been Graves disease. She complained of difficulty with movements of her right arm and leg for some months (she had problems with walking and with rapid, repeated movements of her right hand). She also complained of tremor of her right limbs at rest. She denied taking drugs, having dysphagia, dysarthria, visual changes or sphincter disorders. Neurological examination showed her to have monotonous speech, slight facial hypomimia, slight reduction in spontaneous blinking, walking with less swing of her right arm; postural tremor of both arms, worse on the right; bradykinesia (2/4) of both right limbs and rigidity (1/4), axial and of the right limbs. The results of all the investigations done to rule out secondary Parkinsonism were normal, except for the plasma manganese level which was raised, although it returned to normal when the probable source of exposure to this metal was removed. However, the alterations of movement only disappeared after treatment with levodopa was started.


CONCLUSIONS
In cases of Parkinsonism in young adults secondary causes should always be rules out, such as exposure to certain metals.
Durán
E
E
Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España. jaduran@cica.es
Chacón
J R
JR
D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008345:Manganese / Q000009:adverse effects*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000209:etiology*
D000978:Antiparkinson Agents; D008345:Manganese