title: Chronic manganese toxicity due to substance abuse in Turkish patients.
abstract: BACKGROUND
  Manganese toxicity may lead to a levodopa-resistant akinetic-rigid syndrome. Pathological changes occur mostly in the pallidium and stratium.
  
  
  METHODS
  We report seven patients with a new form of chronic manganese toxicity due to long-term intravenous use of a solution consisting of ephedrine, acetylsalicylic acid and potassium permanganate as a psycho-stimulant, popularly known as "Russian Cocktail".
  
  
  RESULTS
  The age of the patients ranged between 19 and 31 years, and the duration of substance abuse was between nine and 106 months. The onset of symptoms from first use ranged seven to 35 months. The initial symptom was impaired speech followed by gait disturbance and bradykinesia. In addition to these symptoms, choreic movements, ataxia presenting as backward falls and dystonia were also seen. Serum and urine samples revealed high levels of manganese. Hyperintense lesions on T1-weighted magnetic resonance imaging were seen in bilateral basal ganglia and brainstem, dentate nuclei, features consistent with manganese intoxication.
  
  
  CONCLUSIONS
  Manganese toxicity, which may cause a distinctive irreversible neurodegenerative disorder, can be seen frequently with "Russian Cocktail" abuse, a substance which can be accessed very easily and at a low cost.
authors.affiliation: Department of Neurology, Bakirköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Koksal
authors.forename: Sevim
authors.initials: S
authors.lastname: Baybas
authors.forename: Vedat
authors.initials: V
authors.lastname: Sozmen
authors.forename: Neslihan Sutpideler
authors.initials: NS
authors.lastname: Koksal
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Altunkaynak
authors.forename: Ayten
authors.initials: A
authors.lastname: Dirican
authors.forename: Belgin
authors.initials: B
authors.lastname: Mutluay
authors.forename: Hayriye
authors.initials: H
authors.lastname: Kucukoglu
authors.forename: Cahit
authors.initials: C
authors.lastname: Keskinkilic
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D002908:Chronic Disease; D004809:Ephedrine / Q000009:adverse effects*; D006801:Humans; D008297:Male; D020149:Manganese Poisoning / Q000209:etiology*; D019636:Neurodegenerative Diseases / Q000139:chemically induced* / Q000473:pathology; D011196:Potassium Permanganate / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000150:complications*; D014421:Turkey; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000697:Central Nervous System Stimulants; D011196:Potassium Permanganate; D004809:Ephedrine; D001241:Aspirin