SHM Converge Scientific Abstract ePoster Gallery-Hidden in Plain Sight: Manganese Toxicity Masquerading as Parkinson Disease

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This case describes a 61-year-old man initially thought to have Parkinson disease after developing a resting left-hand tremor, progressive imbalance, and recurrent falls over one year. He was later hospitalized after a fall with loss of consciousness and burn injuries. During admission, he was found to have additional neurologic findings including bradykinesia, rigidity, hypokinetic dysarthria, postural instability, freezing, retropulsion, and sensory loss on the left side.<br /><br />Brain imaging showed bilateral basal ganglia abnormalities, and MRI demonstrated symmetric T1 hyperintensity in both globus pallidi, a pattern strongly suggestive of manganese deposition rather than idiopathic Parkinson disease. Further history revealed an important exposure: for six years he lived in a mobile home where he regularly melted manganese bronze in his oven for jewelry-making. This enclosed, repeated exposure was identified as the likely source of chronic manganese toxicity.<br /><br />The report emphasizes that manganese poisoning can closely mimic Parkinson disease because both conditions can cause tremor, rigidity, bradykinesia, and masked facies. However, manganese toxicity often progresses more rapidly and may present with early postural instability and characteristic MRI findings. Recognition of these atypical features is critical to avoid misdiagnosis.<br /><br />Management focuses primarily on stopping exposure. Chelation with CaNa2EDTA may lower systemic manganese levels but has limited benefit for neurologic recovery because it does not effectively penetrate the central nervous system. Levodopa may offer partial symptomatic improvement, as seen in this patient’s tremor, but lasting benefit is usually limited.<br /><br />The main takeaway is that careful social and occupational history, combined with targeted neuroimaging, can identify manganese toxicity and prevent irreversible neurologic injury.

Asset Subtitle

Devika Rajan

Meta Tag

Author List Devika Rajan, Omar Nagy, Priya Rajagopalan, Spencer Liebman

Category Clinical Vignettes

Concept Manganese Toxicity

Concept Parkinsonism

Concept Manganese Exposure

Concept Exposure Removal

Concept Parkinsons Disease

Distinguished Non-Finalist

Presenter Organization Keck School of Medicine of USC

Presenting Author Devika Rajan

Track Adult

Keywords

manganese toxicity

Parkinson disease mimic

globus pallidus hyperintensity

basal ganglia abnormalities

resting tremor

bradykinesia

postural instability

manganese exposure

chelation therapy

occupational history

Manganese Toxicity

Parkinsonism

Manganese Exposure

Exposure Removal

Parkinsons Disease