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Reversal of pallidal magnetic resonance imaging T1 hyperintensity in a welder presenting as reversible Parkinsonism Su-Hyun Han, Suk-Won Ahn, Young C. Youn, Hae-Won Shin Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea We describe an unusual imaging finding in a patient who developed Parkinsonism while working for a welding company.

after leaving his job, the Parkinsonism features had completely resolved and a follow-up brain MRI showed normalized signal intensity [Figure 1b].

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 1a]. At 1 year

In this patient, a welding worker, Parkinsonism and brain MRI results are compatible with manganese intoxication,[1-4] 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.

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Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128366

Address for correspondence: Dr. Hae-Won Shin, Department of Neurology, Chung-Ang University College of Medicine, 224-1, Heukseok-Dong, Dongjak-Gu, Seoul 156-755, South Korea. E-mail: [email protected]

a

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

Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1

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References 1.

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Sadek AH, Rauch R, Schulz PE. Parkinsonism due to manganism in a welder. Int J Toxicol 2003;22:393-401. 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. Bowler RM, Koller W, Schulz PE. Parkinsonism due to manganism in a welder: Neurological and neuropsychological sequelae. Neurotoxicology 2006;27:327-32.

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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.

How to cite this article: Han S, Ahn S, Youn YC, Shin H. Reversal of pallidal magnetic resonance imaging T1 hyperintensity in a welder presenting as reversible Parkinsonism. Neurol India 2014;62:117-8. Source of Support: National Research Foundation of Korea (20110014958), Conflict of Interest: None declared.

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

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