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NEUROIMAGE
Year : 2014  |  Volume : 62  |  Issue : 1  |  Page : 117-118

Reversal of pallidal magnetic resonance imaging T1 hyperintensity in a welder presenting as reversible Parkinsonism


Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea

Date of Web Publication7-Mar-2014

Correspondence Address:
Hae-Won Shin
Department of Neurology, Chung Ang University College of Medicine, 224-1, Heukseok Dong, Dongjak-Gu, Seoul 156-755
South Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.128366

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How to cite this article:
Han SH, Ahn SW, Youn YC, Shin HW. Reversal of pallidal magnetic resonance imaging T1 hyperintensity in a welder presenting as reversible Parkinsonism. Neurol India 2014;62:117-8

How to cite this URL:
Han SH, Ahn SW, Youn YC, Shin HW. Reversal of pallidal magnetic resonance imaging T1 hyperintensity in a welder presenting as reversible Parkinsonism. Neurol India [serial online] 2014 [cited 2020 Jul 14];62:117-8. Available from: http://www.neurologyindia.com/text.asp?2014/62/1/117/128366


We describe an unusual imaging finding in a patient who developed Parkinsonism while working for a welding company.

A 53-year-old male patient was admitted for progressive gait disturbance over 3 months. He had been working for a welding company for 2 years without wearing a protective mask. Neurological examination showed decreased facial expression, marked limb rigidity and bradykinesia. He had a stooped posture and short steps and slow velocity gait. Brain magnetic resonance imaging (MRI) showed increased signal intensity in the bilateral globus pallidus on T1-weighted images with normal intensity on T2-weighted images [Figure 1]a. At 1 year after leaving his job, the Parkinsonism features had completely resolved and a follow-up brain MRI showed normalized signal intensity [Figure 1]b.
Figure 1: (a) T1-weighted images at initial presentation, showing symmetric hyperintensities in the globus pallidus. (b) Resolution of the hyperintense lesions on follow-up magnetic resonance imaging

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In this patient, a welding worker, Parkinsonism and brain MRI results are compatible with manganese intoxication, [1],[2],[3],[4] suggesting that Parkinsonism in this patient was welding-related. He might have been exposed to manganese during welding work as he never used protective brain MRI abnormalities in patients with chronic manganese intoxication are usually irreversible, [2],[4] resulting in persistent clinical Parkinsonism. In our patient, high signal intensity on T1-weighted brain MRI had completely resolved after he left the environment in which he was exposed to manganese. These reversible neuroimaging findings, accompanied by clinical improvement, are unique to chronic intoxication with welding fumes.

 
 » References Top

1.Sadek AH, Rauch R, Schulz PE. Parkinsonism due to manganism in a welder. Int J Toxicol 2003;22:393-401.  Back to cited text no. 1
    
2.Josephs KA, Ahlskog JE, Klos KJ, Kumar N, Fealey RD, Trenerry MR, et al. Neurologic manifestations in welders with pallidal MRI T1 hyperintensity. Neurology 2005;64:2033-9.  Back to cited text no. 2
    
3.Bowler RM, Koller W, Schulz PE. Parkinsonism due to manganism in a welder: Neurological and neuropsychological sequelae. Neurotoxicology 2006;27:327-32.  Back to cited text no. 3
    
4.Kenangil G, Ertan S, Sayilir I, Ozekmekçi S. Progressive motor syndrome in a welder with pallidal T1 hyperintensity on MRI: A two-year follow-up. Mov Disord 2006;21:2197-200.  Back to cited text no. 4
    


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