Video
Asymmetric choreic movements in a case of acquired hypermanganesemia. Video demonstrating involuntary, rapid dance-like movements involving predominantly left upper and lower limbs that flow from one muscle to the other in continuous fashion suggestive of a predominantly left hemichorea (Although the patient had bilateral chorea, left much more than right with motor impersistence, this is not demonstrated in the video).
Figure 1
Brain MRI shows non-enhancing bilateral increased signal intensity on axial T1-weighted (A), axial T2-weighted (B) and axial T2-fluid-attenuated inversion recovery (FLAIR)-weighted (C) images in basal ganglia, with scattered areas of gliosis (T1-weighted images). Gradient-echo axial T2*-weighted image (D) shows no evidence of signal blooming (unlike iron or calcium deposition, manganese deposition does not cause blooming on gradient-echo images or susceptibility-weighted imaging).
Figure 2
Follow-up brain MRI after 6 months: Axial T1-weighted image (A) shows heterogenous signal changes (i.e. bilateral increased signal intensity in basal ganglia possibly due to manganese deposition along with hypointense gliotic areas with mild dilatation of frontal horns of both lateral ventricles). Axial T2-weighted (B) and T2-FLAIR-weighted (C) images show iso- to hypointense signal changes at the areas of deposits and scattered gliotic foci with central hypo and peripheral hyperintense signal changes. Gradient-echo axial T2*-weighted image (D) shows no evidence of signal blooming.
Figure 3
Schematic diagram of the timeline of events in relation to serum manganese level and Mini Mental Status Examination (MMSE) along time.