Manganese Encephalopathy in Setting of a Congenital Extrahepatic Portosystemic Shunt as Cause of Secondary Parkinsonism

Wilson Rodriguez¹*, Ian South², Margarita Fedorova³, Navreet Chennu¹, Lissette Orozco¹, Gunjanpreet Kaur⁴ and Pratap Chand^1
1Department of Neurology, Saint Louis University Hospital, USA
²University of Nebraska Medical Center, USA
³Department of Neurology, Cleveland Clinic, USA
⁴St. Joseph Mercy Ann Arbor hospital, USA
*Corresponding Author: Wilson Rodriguez, Department of Neurology, Saint Louis University, USA.

Published: December 26, 2023

DOI: 10.55162/MCMS.06.184

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Abstract  

Manganese has been shown to deposit in the basal ganglia. While its toxicity has a low incidence, it can result in Parkinsonian syndrome. We describe a case of a 43-year-old man, with medical history of congenital portosystemic shunt, who presented with parkinsonism in the setting of manganese encephalopathy. CTA of abdomen and pelvis showed findings of pelvic portosystemic shunting. Brain MRI with and without contrast showed T1 hyperintensity within the bilateral basal ganglia and anterior midbrain. Patient was started on developed levodopa - carbidopa with mild improvement of motor symptoms but it was stopped due to the development of psychosis. This report emphasizes the importance of early recognition of congenital portosystemic shunt as an etiology of secondary Parkinsonism as early closure of it can be curative.

Keywords: Manganes; Parkinsonism; Levodopa Carbidopa; Portosystemic shunt

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