Parkinsonism caused by chronic usage of intravenous potassium permanganate.
BACKGROUND
Chronic overexposure to manganese (Mn) may cause neuronal degeneration. Manganese intoxication is well known to induce parkinsonism. Manganese intoxication may be associated with abnormal magnetic resonance (MR) imaging (abnormal signal hyperintensity in the globus pallidus and substantia nigra on T1-weighted images).


METHODS
We report an unusual presentation of manganese intoxication due to administration of a combination of acetylsalicylic acid and ephedrine HCl, potassium permanganate, and vinegar melted in tap water and administered parenterally as a psychostimulant substance in 2 cases who developed symptoms resembling parkinsonism. Neurologic examination of both cases revealed disturbances of the extrapyramidal system and a characteristic "cock walk." Tremor was present in the first case, whereas it was lacking in the second one. Cranial MRI showed bilateral symmetric T1-weighted hyperintense patterns in the globus pallidus, probably because of manganese accumulation. Different levels of response to levodopa were reported in the literature; in our cases, there was no response to levodopa.


CONCLUSIONS
Chronic overexposure to manganese may cause an atypical form of parkinsonism associated with increased T1 signal in the basal ganglia on magnetic resonance imaging.
Meral
Hasan
H
Department of Neurology, Haseki Educational and Research Hospital, Istanbul, Turkey.
Kutukcu
Yasar
Y
Atmaca
Birgul
B
Ozer
Feriha
F
Hamamcioglu
Kemal
K
D019342:Acetic Acid / Q000008:administration & dosage; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage; D001921:Brain / Q000187:drug effects* / Q000473:pathology* / Q000503:physiopathology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000737:chemistry / Q000506:poisoning; D004347:Drug Interactions; D004809:Ephedrine / Q000008:administration & dosage / Q000506:poisoning; D020233:Gait Disorders, Neurologic / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology; D005917:Globus Pallidus / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D020149:Manganese Poisoning / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D020734:Parkinsonian Disorders / Q000139:chemically induced* / Q000473:pathology* / Q000503:physiopathology; D011196:Potassium Permanganate / Q000008:administration & dosage / Q000506:poisoning*; D012646:Self Administration
D000697:Central Nervous System Stimulants; D011196:Potassium Permanganate; D004809:Ephedrine; D019342:Acetic Acid; D001241:Aspirin