Parkinsonism Due To Manganese Intoxication: Two Case Reports

Abstract

Background: Chronic exposure to manganese (Mn) fume as in case of welding may cause psychiatric and neurologic symptoms. This chronic intoxication may lead to young-onset Parkinson's disease or parkinsonism resistant to treatment. We present two welders with akinetic-rigid parkinsonism.Patients: Our first case developed parkinsonism accompanied by severe postural instability, dystonia, typical cock gait and pyramidal findings after 10 years of welding at the age of thirties which progressed rapidly in 1.5 years and was unresponsive to dopaminergic agents. His MRI showed bilateral symmetric pathological signal changes in the basal ganglia, being most prominent in the globus pallidum. Our second case developed asymmetric, slowly progressive dopa-responsive parkinsonism with unremarkable MRI findings similar to idiopathic variety after 30 years of welding at the age of 44 while he was working.