[Brain MRI associated with chronic hepatic failure and hypermanganism].
BACKGROUND
Hypermanganism is primarily linked to inhalation exposure. Several observations of exogenous manganese poisoning have been reported associating neuropsychiatric symptoms, parkinsonian syndrome and hyperintensities of the two pallida on T1 weighted sequences on brain MRI. Recently, similar neurological and radiological signs have been described without exogenous exposure to manganese but in the framework of endogenous poisoning particularly in chronic hepatic failure.


METHODS
We report the case of a 41-year-old HIV-positive and HVC-positive man who presented psychomotor impairment associated with bipallidal T1 hyperintensities on the brain MRI. The diagnosis of a hypermanganesemia was made on blood samples. We present a literature review on exogenous and endogenous hypermanganesemia and discuss differential diagnosis in the radiological setting of bipallidal T1 hyperintensities.


CONCLUSIONS
Bipallidal T1 hyperintensities on brain MRI may suggest hypermanganism even in the clinical setting of a non-specific neurological disorder such as psychomotor impairment.
Aissi
M
M
Service de neurologie, unité neurovasculaire, centre hospitalier de Versailles, hôpital André-Mignot, université de Versailles Saint-Quentin-en-Yvelines, 1, rue Richaud, 78000 Versailles, France.
Nifle
C
C
Roussin Bretagne
S
S
Hubert
C
C
Cordoliani
Y-S
YS
Pico
F
F
D000328:Adult; D001921:Brain / Q000473:pathology*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005917:Globus Pallidus / Q000187:drug effects / Q000473:pathology; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000097:blood; D020149:Manganese Poisoning / Q000150:complications / Q000175:diagnosis*
D008345:Manganese