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[18F]FDOPA PET and clinical features in parkinsonism due to manganism

Authors

  • Brad A. Racette MD,

    Corresponding author
    1. Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
    2. American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA
    • Washington University School of Medicine, 660 South Euclid Ave., Box 8111, St. Louis, MO 63110
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  • Jo Ann Antenor MPH,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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  • Lori McGee-Minnich BSN,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
    2. American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA
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  • Stephen M. Moerlein PhD,

    1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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  • Tom O. Videen PhD,

    1. Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
    2. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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  • Vikas Kotagal BSN,

    1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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  • Joel S. Perlmutter MD

    1. Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
    2. American Parkinson Disease Association Advanced Center for Parkinson Research, Washington University School of Medicine, St. Louis, Missouri, USA
    3. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
    4. Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract

Manganese exposure reportedly causes a clinically and pathophysiologically distinct syndrome from idiopathic Parkinson's disease (PD). We describe the clinical features and results of positron emission tomography with 6-[18F]fluorodopa ([18F]FDOPA PET) of a patient with parkinsonism occurring in the setting of elevated blood manganese. The patient developed parkinsonism associated with elevated serum manganese from hepatic dysfunction. [18F]FDOPA PET demonstrated relatively symmetric and severely reduced [18F]FDOPA levels in the posterior putamen compared to controls. The globus pallidum interna had increased signal on T1-weighted magnetic resonance imaging (MRI) images. We conclude that elevated manganese exposure may be associated with reduced striatal [18F]FDOPA uptake, and MRI may reveal selective abnormality within the internal segment of the pallidum. This case suggests that the clinical and pathophysiological features of manganese-associated parkinsonism may overlap with that of PD. © 2005 Movement Disorder Society

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