title: A preliminary study revealing a new association in patients undergoing maintenance hemodialysis: manganism symptoms and T1 hyperintense changes in the basal ganglia.
abstract: OBJECTIVE
  Patients undergoing parenteral nutrition and those with portosystemic encephalopathy secondary to chronic liver disease and acquired and congenital portosystemic venous shunts frequently present manganese deposition in the basal ganglia, detected by MR imaging as hyperintense areas on T1-weighted sequences. We also observed similar abnormalities in the basal ganglia of patients with chronic renal failure undergoing maintenance hemodialysis. Our aim was to evaluate the pallidal signal intensity on T1-weighted images in a series of patients undergoing hemodialysis, with further evaluation of serum manganese levels and neurologic correlation, comparing them with patients with chronic renal failure without dialytic treatment.
  
  
  METHODS
  We performed MR imaging examinations in 9 patients with chronic renal failure, 5 of whom were undergoing hemodialysis. An experienced neuroradiologist scrutinized the presence of symmetric hyperintensities in the basal ganglia on T1-weighted sequences. We also determined the serum manganese levels and performed the neurologic evaluations in all patients.
  
  
  RESULTS
  All patients undergoing hemodialysis presented elevated serum manganese levels and symmetric hyperintensities within the globus pallidus. In this group, 4 patients presented with parkinsonian symptoms, myoclonus, and syndromes with vestibular and vestibular-auditory symptoms. The patients without dialytic treatment presented with neither bilaterally increased T1 MR imaging signal intensity within the globus pallidus nor symptoms of manganism.
  
  
  CONCLUSIONS
  Our preliminary results demonstrated the occurrence of bilateral pallidal hyperintensity on T1-weighted images in all patients undergoing hemodialysis associated with high serum manganese levels, revealing a new association.
authors.affiliation: Section of Radiology, Laboratório Fleury-Centro de Medicina Diagnóstica, São Paulo-SP, Brazil. carlos.silva@fleury.com.br
authors.forename: C J
authors.initials: CJ
authors.lastname: da Silva
authors.forename: A J
authors.initials: AJ
authors.lastname: da Rocha
authors.forename: S
authors.initials: S
authors.lastname: Jeronymo
authors.forename: M F
authors.initials: MF
authors.lastname: Mendes
authors.forename: F T
authors.initials: FT
authors.lastname: Milani
authors.forename: A C M
authors.initials: AC
authors.lastname: Maia
authors.forename: F T
authors.initials: FT
authors.lastname: Braga
authors.forename: Y A S
authors.initials: YA
authors.lastname: Sens
authors.forename: L A
authors.initials: LA
authors.lastname: Miorin
mesh_terms: D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000473:pathology*; D005260:Female; D005917:Globus Pallidus / Q000473:pathology; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D020149:Manganese Poisoning / Q000150:complications / Q000209:etiology*; D008875:Middle Aged; D009207:Myoclonus / Q000209:etiology; D020734:Parkinsonian Disorders / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects*; D013577:Syndrome; D015837:Vestibular Diseases / Q000209:etiology