A Study Of MR Imaging Of The Basal Ganglia And Serum Manganese Concentration In Cirrhotic Patients With Portosystemic Shunting

Abu Zeid, Hani; Aggag, Mohamed Farouk; Ismail, Walid Foad; Abdullah, Ola M.

doi:10.21608/ejhm.2004.18178

A Study Of MR Imaging Of The Basal Ganglia And Serum Manganese Concentration In Cirrhotic Patients With Portosystemic Shunting

Document Type : Original Article

Authors

¹ Departments of Internal Medicine Faculty of Medicine Al Azhar university – Cairo.

² Departments of Radiology Faculty of Medicine Al Azhar university – Cairo.

³ Neurology Faculty of Medicine Al Azhar university – Cairo.

⁴ Department of analytical chemistryFaculty of Pharmacy (girls) Al Azhar university-Cairo.

10.21608/ejhm.2004.18178

Abstract

Manganese in normally removed by hepatobiliary route. In long term hepatic dysfunction with portosystemic shunting it accumulates in systemic circulation and may deposit in CNS particularly in the basal ganglia, resulting in permanent extrapyramidal manifestations and a unique form of parkinsonism characterized by early gait impairment, postural fine tremor, symmetric akinetic rigidity and sometimes associated with focal dystonia (Purkhard et al., 2003). In this study: 50 male cirrhotic patients, aged 28 –59 years, were selected from Internal Medicine department – Al Hussein university hospital, in addition to 20 age-matched healthy males as a control group. All subjects (patients & controls) were submitted to (1) Full clinical & laboratory examination including liver function tests and serum manganese estimation using atomic absorption technique. (2) Abdominal triphasic spiral CT scanning for evaluation of portosystemic collaterals and to assess the hepatic intensity and the splenic size (3) MR Imaging of the brain. We have concluded that: (i) The studied cirrhotic patients had a statistically higher serum manganese concentration than that of the controls. (ii) 24/50 patients (48%) showed variable degrees of basal ganglia hyperintensity on T1- weighted MR images, associated with marked elevation of serum manganese levels (five to seven fold the normal level) and advanced grades of gastroesophageal varices on triphasic spiral CT scanning (iii) 26/50 patients (52%) showed normal intensity in the basal ganglia on T1- weighted MR images with relatively Lower levels of serum manganese (two to four fold the normal level) and early grade of gastroesophageal varices on triphasic spiral CT scanning (iv) serum manganese concentration of cirrhotic patients with hyperintensity in the basal ganglia on T1 weighted MR imaging was statistically higher than that of cirrhotic patients with normal intensity – basal ganglia.