The New England Journal of MedicineImages in Clinical Medicine: Manganese Accumulation in the Brain

Manganese Poisoning: A Silent Occupational Hazard with Potential Neurological Consequences

A recent case study highlights the potential neurotoxic effects of occupational exposure to heavy metals, specifically manganese, in a 55-year-old man who presented with a decade-long history of progressive handwriting impairment and rapid, slurred speech. The patient’s previous work as a welder without personal protective equipment, coupled with his neurologic symptoms and MRI findings, led to a diagnosis of manganese poisoning.

Key Points

• The patient, a former welder, presented with 10 years of progressive handwriting impairment and rapid, slurred speech.
• Neurologic examination revealed reduced facial expression, blepharospasm, and cluttered, dysarthric speech.
• MRI of the head showed a nonenhancing, T1-weighted, hyperintense signal in the basal ganglia on both sides.
• Despite normal results of laboratory tests including a serum iron panel and measurements of ceruloplasmin and urinary copper excretion, a diagnosis of manganese poisoning was made based on the patient’s occupational history and neurologic syndrome.
• Treatment with intravenous EDTA for 6 months led to an abatement of the patient’s symptoms and resolution of the abnormal MRI findings.

According to the World Health Organization (WHO), millions of workers worldwide are exposed to manganese in the workplace primarily through inhalation.

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