title: Manganese-induced Parkinsonism in a patient undergoing maintenance hemodialysis.
abstract: We report a rare case of manganese (Mn)-induced parkinsonism in a patient on maintenance hemodialysis therapy who complained of gait disturbance and dysarthria. His symptoms and abnormal magnetic resonance imaging (MRI) findings of the brain were thought to be caused, at least in part, by long-term ingestion of a health supplement (Chlorella extract) that contained 1.7 mg of Mn in the usual daily dose. Elevated serum and cerebrospinal fluid Mn levels were detected, and brain MRI showed areas of abnormal intensity in the bilateral basal ganglia (low intensity on T1-weighted images and high intensity on T2-weighted images). Edetic acid infusion therapy dramatically improved the MRI abnormalities, after which his symptoms gradually improved 4 months later.
authors.affiliation: Department of Nephrology, Kidney & Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan. ohtake@shonankamakura.or.jp
authors.forename: Takayasu
authors.initials: T
authors.lastname: Ohtake
authors.forename: Kousuke
authors.initials: K
authors.lastname: Negishi
authors.forename: Kouji
authors.initials: K
authors.lastname: Okamoto
authors.forename: Machiko
authors.initials: M
authors.lastname: Oka
authors.forename: Kyoko
authors.initials: K
authors.lastname: Maesato
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Moriya
authors.forename: Shuzo
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D019661:Apiaceae / Q000737:chemistry*; D001479:Basal Ganglia / Q000473:pathology; D002614:Chelating Agents / Q000627:therapeutic use; D015913:Chelation Therapy; D002708:Chlorella / Q000737:chemistry*; D003928:Diabetic Nephropathies / Q000150:complications / Q000628:therapy; D019587:Dietary Supplements / Q000009:adverse effects*; D004401:Dysarthria / Q000139:chemically induced; D004492:Edetic Acid / Q000627:therapeutic use; D020233:Gait Disorders, Neurologic / Q000139:chemically induced; D006236:Handwriting; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000009:adverse effects* / Q000097:blood / Q000134:cerebrospinal fluid; D008875:Middle Aged; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D028321:Plant Preparations / Q000009:adverse effects* / Q000737:chemistry; D006435:Renal Dialysis
chemical_list: D002614:Chelating Agents; D028321:Plant Preparations; D008345:Manganese; D004492:Edetic Acid