Liver transplantation in a patient with rapid onset parkinsonism-dementia complex induced by manganism secondary to liver failure.
Bilateral and symmetric globus-pallidus hyperintensities are observed on T1-weighted MRI in most of the patients with chronic liver failure, due to manganese accumulation. We report a 53-year-old man, with rapid onset parkinsonism-dementia complex associated with accumulation of manganese in the brain, secondary to liver failure. A brain MRI was performed and a high signal on T1-weighted images was seen on globus-pallidus, as well as on T2-weighted images on the hemispheric white-matter. He was referred to a liver-transplantation. The patient passed away on the seventh postoperative day. Our findings support the concept of the toxic effects of manganese on the globus-pallidus. The treatment of this form of parkinsonism is controversial and liver-transplantation should not be considered as first line treatment but as an alternative one.
Fabiani
Giorgio
G
Department of Neurology, Hospital de Caridade da Irmandade, Santa Casa de Misericórdia de Curitiba, Pontifícia Universidade Católica do Paraná, 80035-180 Curitiba, PR, Brazil. giorgiofabiani@terra.com.br
Rogacheski
Enio
E
Wiederkehr
Júlio César
JC
Khouri
Jussara
J
Cianfarano
Andréa
A
D003704:Dementia / Q000139:chemically induced / Q000473:pathology / Q000601:surgery*; D017809:Fatal Outcome; D005917:Globus Pallidus / Q000473:pathology / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D020149:Manganese Poisoning / Q000150:complications*; D008875:Middle Aged; D010302:Parkinson Disease, Secondary / Q000139:chemically induced / Q000473:pathology / Q000601:surgery*