Case presentation: We report a 30-year-old Eastern European man who presented with a two-year history of gait disturbance. [drugsandalcohol.ie]

We describe the case of a man who presented with recurrent episodes of confusion, psychosis, dystonic limb movement and cognitive impairment and was initially diagnosed with anti-voltage-gated potassium channel (VGKC) complex limbic encephalitis in view [ncbi.nlm.nih.gov]

It is a trace mineral present in the human body in small quantities, primarily in the bones, liver, kidneys and pancreas. [watertechonline.com]

• Fatigue

  Headaches, muscle cramps, fatigue, and aggressiveness are early signs of manganese toxicity, which can then proceed into Parkinson’s disease-like symptoms such as tremors ( 6 ). [veganhealth.org]

  Chronic manganese intoxication has an insidious and progressive course and usually starts with complaints of headache, fatigue, sleep disturbances, irritability and emotional instability. [jmedicalcasereports.biomedcentral.com]

  Heat, fatigue, stress, driving aggravate. These were changes in my life-long patterns of feeling and behavior. Other people might be affected differently or not as severely. [digitalfire.com]

• Asymptomatic

  Kim Y, Kim KS, Yang JS, Park IJ, Kim E, Jin Y, Kwon KR, Chang KH, Kim JW, Park SH, Lim HS, Cheong HK, Shin YC, Park J, Moon Y: Increase in signal intensities on T1-weighted magnetic resonance images in asymptomatic manganese-exposed welders. [jmedicalcasereports.biomedcentral.com]

• Cough

  Anxiety Impotence Late manifestations Tremor Impaired speech Loss of facial expressions Gait disturbances Low volume speech Can mimic Parkinson’s disease Pulmonary Acute / Metal fume fever Fever Nausea Headache Myalgia Arthralgia Chronic Persistent dry cough [wikem.org]

  Jankovic points out that in acute manganese intoxication “cough and shortness of breath, as well as headaches occur early. [parkinson.org]

• Nausea

  Manganese madness” Visual hallucinations Behavioral changes Anxiety Impotence Late manifestations Tremor Impaired speech Loss of facial expressions Gait disturbances Low volume speech Can mimic Parkinson’s disease Pulmonary Acute / Metal fume fever Fever Nausea [wikem.org]

  I blamed my violent nausea after each raku firing on carbon monoxide and tried to avoid inhaling any smoke. [digitalfire.com]

• Jaundice

  Both these patients developed ascites and severe jaundice and 1 expired one year after surgery. HIDA scan was excretory in all 14 patients. [ncbi.nlm.nih.gov]

  Hepatitis Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. [digitalnaturopath.com]

• Sweating

  […] slurred speech, mask-like face, and a general clumsiness. 3) FINAL STAGE : is characterized by more acute and incapacitating neurological impairment including limb rigidity, mild tremors, dystonic, gait disturbance, cock-like walk, excessive salivation, sweating [flipper.diff.org]

  It is important to sweat. The essential tremor is much better after hot exercise. Carbon monoxide and other minerals cause manganese toxicity to have a worse tremor, according to the library work. [digitalfire.com]

Thus, the combined pharmacological actions of riluzole as both an antioxidant and inhibitor of glutamate activity may make it an ideal drug for the treatment of manganism. [ubir.buffalo.edu]

“Strikingly, treatment of one child who was severely affected led to such a dramatic improvement of her symptoms that she even regained her ability to walk.” [action.org.uk]

An useful diagnostic criterion to distinguish between manganism and Parkinson's disease consist in the fact that L-DOPA treatment is basically ineffective as treatment for manganism. [flipper.diff.org]

Then, over 3 months, she received an experimental treatment of 15 intravenous infusions of para-aminosalicylic acid (PAS), a relative of aspirin that is used to treat tuberculosis. [sciencemag.org]

[…] para -Aminosalicylic acid in the treatment of manganese toxicity. [pubs.rsc.org]

This tool can be used for prognosis after Kasai's portoenterostomy and can also be extremely useful in selecting patients who will need a liver transplant on a priority basis. [ncbi.nlm.nih.gov]

This case study suggests that PAS appears to be an effective drug for treatment of severe chronic Mn poisoning with a promising prognosis. Authors: Tommaso Pierani and Luca Rodano. [flipper.diff.org]

An extended body of literature is now available on: different exposure sources and routes of absorption; mechanistic aspects provided also by imaging assessment; dose–response relationship from epidemiological and animal studies; gender differences; genetic [oem.bmj.com]

The recent publication, in the American Journal of Epidemiology, addressing metal emission and urban incidence of Parkinson’s disease (PD) underscores the public’s growing concern that manganese, copper, and other metals may play a role as an environmental [parkinson.org]

[…] human embryonic kidney (HEK293) cells is associated with decreased intracellular manganese concentration and attenuated cytotoxicity, characterized by the reversal of Mn-reduced glutamate uptake and diminished lactate dehydrogenase (LDH) leakage. [3] Epidemiology [en.wikipedia.org]

Cikrt, Journal of Hygiene, Epidemiology, Microbiology & Immunology. 28(2):139-48. 1984. "Manganese exposure in steel smelters a health hazard to the nervous system," A. Wennberg et al. [digitalfire.com]

Mn has been also implicated in the pathophysiology of several other neurodegenerative diseases. [ncbi.nlm.nih.gov]

[…] methylcyclopentadienyl manganese tricarbonyl (MMT), [12] which on combustion becomes partially converted into manganese phosphates and sulfate that go airborne with the exhaust, [13] [14] [15] and manganese ethylene-bis-dithiocarbamate ( Maneb ), a pesticide. [16] Pathophysiology [en.wikipedia.org]

This unresponsiveness to (L-dopa) is most likely related to the difference in the pathophysiology between idiopathic and Mn-induced parkinsonism. [jmedicalcasereports.biomedcentral.com]

Prevention Prevention of soil acidity is the best control of manganese toxicity. Your best approach is to follow a planned rotation. A grass or a grass-legume sod is usually best in a tobacco rotation. [www2.ca.uky.edu]

This is supported by studies demonstrating that blocking of the glutamate receptors with the NMDA receptor antagonist, MK-801, prevents lesions produced by intrastriatal injections of Mn. [ubir.buffalo.edu]

Symptoms of Mn intoxication (""""""""manganism"""""""") resemble those in idiopathic Parkinson's disease (IPD) and usually become progressive and irreversible, making early diagnosis crucial for prevention of Mn intoxication in the occupational and environmental [grantome.com]

Characteristics and occurrence Manganese (Mn) is frequently an abundant constituent of soils, but its low solubility at neutral and alkaline pH prevents excessive uptake by plants. [keys.lucidcentral.org]