Neurology: Case of the Month

Test Yourself — Patient 50

Parkinsonism Due to Manganese Toxicity

  1. The radiographic finding MOST suggestive of manganese toxicity is:
    • [ A ] Punctate hyperdensities in the basal ganglia on CT (without contrast)
    • [ B ] Punctate hyperdensities in cortical sulci on CT (without contrast)
    • [ C ] Symmetric globus pallidus hyperintensities on T2-weighted MRI
    • [ D ] Symmetric basal ganglia hyperintensities on T1-weighted MRI
    • [ E ] Symmetric basal ganglia hypointensities on T2-weighted MRI
  2. The MOST effective treatment for manganese-induced parkinsonism is:
    • [ A ] Pallidotomy
    • [ B ] Removal of exposure
    • [ C ] Levodopa
    • [ D ] Hemodialysis
    • [ E ] Dopaminergic neuronal transplantation
  3. Which of the following statements is TRUE in a young patient with parkinsonism?
    • [ A ] Failure to respond to levodopa generally rules out manganese toxicity.
    • [ B ] Symmetric onset of symptoms often suggests a secondary cause of parkinsonism.
    • [ C ] Testing for Wilson's disease is unwarranted in the absence of a family history.
    • [ D ] Denial of neuroleptic exposure excludes a drug-induced cause of parkinsonism.
  4. The most commonly recognized route of manganese entry in cases of Mn toxicity is:
    • [ A ] Ingestion
    • [ B ] Transdermal absorption
    • [ C ] Inhalation
    • [ D ] Intravenous feedings
    • [ E ] Unknown (i.e., never determined)
  5. A diagnosis of manganese toxicity can be considered definitive only if greatly elevated serum levels and/or urinary excretion (> 2 x upper limit of normal) can be demonstrated.
    • [ A ] True
    • [ B ] False

 

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