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American Journal of Neuroradiology 28:1474-1479, September 2007
DOI 10.3174/ajnr.A0600
© 2007 American Society of Neuroradiology

BRAIN

A Preliminary Study Revealing a New Association in Patients Undergoing Maintenance Hemodialysis: Manganism Symptoms and T1 Hyperintense Changes in the Basal Ganglia

C.J. da Silva^a,c, A.J. da Rocha^a,c, S. Jeronymo^b, M.F. Mendes^d, F.T. Milani^e, A.C.M. Maia, Jr^a, F.T. Braga^a,c, Y.A.S. Sens^e and L.A. Miorin^e

^a Sections of Radiology, Laboratório Fleury-Centro de Medicina Diagnóstica, São Paulo-SP, Brazil
^b Biochemistry, Laboratório Fleury-Centro de Medicina Diagnóstica, São Paulo-SP, Brazil
^c Sections of Radiology, Santa Casa de Misericórdia de São Paulo, São Paulo-SP, Brazil
^d Neurology, Santa Casa de Misericórdia de São Paulo, São Paulo-SP, Brazil
^e Nephrology, Santa Casa de Misericórdia de São Paulo, São Paulo-SP, Brazil

Please address correspondence to Carlos Jorge da Silva, MD, Centro de Medicina Diagnóstica-Setor de Imagem, Laboratório Fleury, Rua Cincinato Braga, 282, Paraíso, CEP 01333910, São Paulo-SP, Brazil; e-mail: carlos.silva{at}fleury.com.br

BACKGROUND AND PURPOSE: Patients undergoing parenteral nutrition and those with portosystemic encephalopathy secondary to chronic liver disease and acquired and congenital portosystemic venous shunts frequently present manganese deposition in the basal ganglia, detected by MR imaging as hyperintense areas on T1-weighted sequences. We also observed similar abnormalities in the basal ganglia of patients with chronic renal failure undergoing maintenance hemodialysis. Our aim was to evaluate the pallidal signal intensity on T1-weighted images in a series of patients undergoing hemodialysis, with further evaluation of serum manganese levels and neurologic correlation, comparing them with patients with chronic renal failure without dialytic treatment.

MATERIALS AND METHODS: We performed MR imaging examinations in 9 patients with chronic renal failure, 5 of whom were undergoing hemodialysis. An experienced neuroradiologist scrutinized the presence of symmetric hyperintensities in the basal ganglia on T1-weighted sequences. We also determined the serum manganese levels and performed the neurologic evaluations in all patients.

RESULTS: All patients undergoing hemodialysis presented elevated serum manganese levels and symmetric hyperintensities within the globus pallidus. In this group, 4 patients presented with parkinsonian symptoms, myoclonus, and syndromes with vestibular and vestibular-auditory symptoms. The patients without dialytic treatment presented with neither bilaterally increased T1 MR imaging signal intensity within the globus pallidus nor symptoms of manganism.

CONCLUSION: Our preliminary results demonstrated the occurrence of bilateral pallidal hyperintensity on T1-weighted images in all patients undergoing hemodialysis associated with high serum manganese levels, revealing a new association.

This article has been cited by other articles:

				C. Jorge da Silva, A. Jose da Rocha, M. F. Mendes, A. P. S. d. M. Braga, and S. Jeronymo Brain Manganese Deposition Depicted by Magnetic Resonance Imaging in a Welder Arch Neurol, July 1, 2008; 65(7): 983 - 983. [Full Text] [PDF]