title: [A case of idiopathic portal hypertension (IPH) with hypermanganemia presenting as spastic gait].
abstract: A 48-year-old women was admitted to our hospital because of gradually developed spastic gait. She showed spasticity of the lower extremities with mild weakness. Laboratory tests disclosed decreased WBC and platelet counts and mild increases of transaminase and total bilirubin. Blood manganese level was markedly increased (6.0 micrograms/dl). Abdominal ultrasound showed splenomegaly, and abdominal angiography showed a dilatation of the portal and paraumbilical veins. T1-weighted MR images showed high signal intensities at the bilateral globus pallidus and cerebral peducles, and T2-weighted images showed high signal intensities at the bilateral deep white matter, posterior limbs of the internal capsule and right upper cervical spinal cord. Following the diagnosis of IPH, splenectomy was performed. The blood level of manganese decreased thereafter and her neurological deficits gradually improved. Hepatic diseases often show high signal intensities at the basal ganglia on T1-weighted images, and this seemed to be due to accumulation of manganese in our case. Because demyelination or axonal injury of the spinal cord are found in hepatic disease, we speculate that the high signal intensities at the spinal cord on T2-weighted images of our case reflect hepatic myelopathy, which may also be caused by high blood levels of manganese.
authors.affiliation: Department of Neurology, Tokai University School of Medicine.
authors.forename: Ruriko
authors.initials: R
authors.lastname: Obama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tachikawa
authors.forename: Fumihito
authors.initials: F
authors.lastname: Yoshii
authors.forename: Tsuneyuki
authors.initials: T
authors.lastname: Takeoka
authors.forename: Yukito
authors.initials: Y
authors.lastname: Shinohara
mesh_terms: D001921:Brain / Q000473:pathology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008345:Manganese / Q000097:blood*; D008875:Middle Aged; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology*; D013156:Splenectomy; D016896:Treatment Outcome
chemical_list: D008345:Manganese