INCREASED BLOOD MANGANESE IN CIRRHOTIC-PATIENTS - RELATIONSHIP TO PALLIDAL MAGNETIC-RESONANCE SIGNAL HYPERINTENSITY AND NEUROLOGICAL SYMPTOMS

Increasing evidence suggests that manganese deposition is responsible for the T-1-weighted magnetic resonance imaging (MRI) signal hyperinte nsity consistently observed in pallidum of cirrhotic patients, However , the relationship between blood manganese and the etiology or severit y of liver disease, as well as the neurological symptomatology in thes e patients, has not been well established. In the present study, blood manganese concentrations were measured by atomic absorption spectrome try together with MRI and neurological evaluation in 57 cirrhotic pati ents with various etiologies and severity of Liver disease, Blood mang anese concentrations were elevated in 67% of cirrhotic patients and we re significantly higher in patients with previous portacaval anastomos es or transjugular intrahepatic portosystemic shunt (TIPS), Pallidal s ignal hyperintensity was observed in 88% of patients, and significant correlations were demonstrated between blood manganese and pallidal in dex (PI) (a measure of pallidal signal hyperintensity), as well as Chi ld-Pugh score, Assessment of extrapyramidal symptoms using the Columbi a rating scale revealed a significant incidence of tremor, rigidity, o r akinesia in up to 89% of cirrhotic patients. However, there was no s ignificant correlation between blood manganese and extrapyramidal symp toms, although severity of akinesia was significantly greater in Child -Pugh C patients, Extrapyramidal symptoms could result from a toxic ef fect of manganese on basal ganglia dopaminergic function, These findin gs further support a role for manganese in the etiology of pallidal MR I signal hyperintensity in patients with chronic liver disease.