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Manganese Deposition in the Brain During Long-Term Total Parenteral Nutrition

Department of Pediatrics, Osaka University Medical School, Division of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan

Koushi Harada, MD

Department of Radiology, Osaka University Medical School

Ryuhei Kodaka, MD

Department of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan

Kosuke Sakurai, MD

Department of Radiology, Osaka University Medical School

Hitoshi Tajiri, MD

Department of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan

Yoji Takagi, MD

Department of Pediatric Surgery, Osaka University Medical School

Toshisaburo Nagai, MD

Department of Pediatrics, Osaka University Medical School

Tokuzo Harada, MD

Department of Pediatrics, Osaka University Medical School

Akio Nihei, MD

Division of Pediatrics, Toyonaka Municipal Hospital, Osaka, Japan

Akira Okada, MD

Department of Pediatric Surgery, Osaka University Medical School

Shintaro Okada, MD

Department of Pediatrics, Osaka University Medical School

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 µg/L (normal range 14.6 ± 4.7 µg/L), whereas the level was 20 µg/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 T1-weighted magnetic resonance images. (Journal of Parenteral and Enteral Nutrition 19:310-312, 1995)

Journal of Parenteral and Enteral Nutrition, Vol. 19, No. 4, 310-312 (1995)
DOI: 10.1177/0148607195019004310


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