MANGANESE DEPOSITION IN THE BRAIN DURING LONG-TERM TOTAL PARENTERAL-NUTRITION

Background: Manganese deposition was suspected in a pediatric patient who received long-term total parenteral nutrition T1-weighted magnetic resonance images revealed high intensity areas in the globus pallidus . This study was designed to clarify if these abnormal findings were r elated to manganese deposition and clinical neurological manifestation s. Methods: Whole-blood manganese concentrations were measured during manganese supplementation to total parenteral nutrition and after 5 mo nths without manganese. Magnetic resonance images were also examined o n each occasion and compared with the blood level of manganese. Result s: The whole-blood manganese level during supplementation was 135 mu g /L (normal range 14.6 +/- 4.7 mu g/L), whereas the level was 20 mu g/L after a manganese-free period of 5 months. Accompanied with normaliza tion of manganese level, abnormal high intensity lesions in the globus pallidus on T1-weighted images also disappeared. No neurological mani festation related to the high manganese level was recognized. Conclusi ons: It is probable that the high manganese level was elicited by mang anese supplementation to total parenteral nutrition. This high mangane se condition was confirmed by the measurement of whole-blood manganese level, which was associated with the abnormal high intensity lesions on TI-weighted magnetic resonance images.