Hyperintense basal ganglia on T1-weighted magnetic resonance images following postoperative parenteral nutrition in a pancreatoduodenectomized patient

The authors reported the magnetic resonance imaging (MRI) detection of mang anese (Mn) deposition in the basal ganglia of a pancreatoduodenectomized pa tient following 30-day parenteral nutrition. A multi-trace element suppleme nt solution including 20 mu mol Mn/day was parenterally administered for 30 days postoperatively. The serum level of total bilirubin normalized on the 3rd postoperative day, while the level of alkaline phosphatase continued t o exceed the higher limit of normal controls even 2 months after operation. T1-weighted MRI on the 49th postoperative day demonstrated bilateral and s ymmetrical hyperintense lesions in the globus pallidus. The whole-blood Mn level on the 67th postoperative day was 3.1 (normal range 0.8-2.5) mu g/l. T1-weighted MRI on the 103 rd postoperative day revealed improvement in the hyperintense lesions, and MRI on the 225th postoperative day revealed no a bnormality. The blood Mn level normalized on the 194th postoperative day. E ven short-term postoperative parenteral nutrition may result in Mn depositi on in the brain, especially in patients with cholestasis following pancreat oduodenectomy. Copyright (C) 2000 S. Karger AG. Basel.