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 related to manganese deposition and clinical neurological manifestations. Methods: Whole-blood manganese concentrations were measured during manganese supplementation to total parenteral nutrition and after 5 months without manganese. Magnetic resonance images were also examined on each occasion and compared with the blood level of manganese. Results: 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 normalization of manganese level, abnormal high intensity lesions in the globus pallidus on T1-weighted images also disappeared. No neurological manifestation related to the high manganese level was recognized. Conclusions: It is probable that the high manganese level was elicited by manganese supplementation to total parenteral nutrition. This high manganese 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.