Hypermanganesemia Induced Chorea and Cognitive Decline in a Tea Seller.

摘要: Background: Manganese associated neurotoxicity and neurodegeneration is quite rare yet established neurological disorder. This neurotoxic element has predilection for depositing in basal ganglia structures, manifesting mainly as parkinsonian dystonic movement disorders with behavioral abnormalities. Case report: We report a 40-year-old man who presented subacute onset bilateral, asymmetric hyperkinetic disorder (predominantly left sided chorea) multi-domain cognitive impairment, dysarthria, generalized rigidity. Clinical history examination yielded multiple differential diagnoses including deposition metabolic disorders, autoimmune paraneoplastic encephalitis involving ganglia, neurodegenerative chorea impairment. However, magnetic resonance imaging was suggestive of paramagnetic substance deposition, which came out to be manganese after laboratory investigations. History, clinical examinations, investigation results pointed towards diagnosis acquired hypermanganesemia due over-ingestion containing (i.e., black tea). He treated symptomatically chelation therapy (calcium disodium edetate). At the sixth month follow-up, complete resolution chorea, dysarthria partial amelioration rigidity were observed. His decline abnormalities improved. Discussion: probably first reported case that combination dysfunction atypical characteristics. The picture mimicked Huntington’s disease. highlight potential deleterious effects an apparently “benign” non-alcoholic beverage tea) on cerebral metabolism.