title: [18F]FDOPA PET and clinical features in parkinsonism due to manganism.
abstract: Manganese exposure reportedly causes a clinically and pathophysiologically distinct syndrome from idiopathic Parkinson's disease (PD). We describe the clinical features and results of positron emission tomography with 6-[18F]fluorodopa ([18F]FDOPA PET) of a patient with parkinsonism occurring in the setting of elevated blood manganese. The patient developed parkinsonism associated with elevated serum manganese from hepatic dysfunction. [18F]FDOPA PET demonstrated relatively symmetric and severely reduced [18F]FDOPA levels in the posterior putamen compared to controls. The globus pallidum interna had increased signal on T1-weighted magnetic resonance imaging (MRI) images. We conclude that elevated manganese exposure may be associated with reduced striatal [18F]FDOPA uptake, and MRI may reveal selective abnormality within the internal segment of the pallidum. This case suggests that the clinical and pathophysiological features of manganese-associated parkinsonism may overlap with that of PD.
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.|American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Brad A
authors.initials: BA
authors.lastname: Racette
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Antenor
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.|American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: McGee-Minnich
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Moerlein
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.|Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Tom O
authors.initials: TO
authors.lastname: Videen
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Kotagal
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.|American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA.|Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.|Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Perlmutter
mesh_terms: D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001921:Brain / Q000378:metabolism*; D002230:Carbidopa / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D019788:Fluorodeoxyglucose F18; D005684:Gait; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D020149:Manganese Poisoning / Q000097:blood* / Q000150:complications*; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
chemical_list: D000978:Antiparkinson Agents; D004338:Drug Combinations; D019275:Radiopharmaceuticals; C009265:carbidopa, levodopa drug combination; D019788:Fluorodeoxyglucose F18; D007980:Levodopa; D002230:Carbidopa