脳卒中患者のIVH管理によるマンガン中毒 : パーキンソン様症状によるリハビリテーションの阻害とその回復

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A 68-year-old male suffering from γ-thalamic hemorrhage associated with a ventricular rupture was given total parenteral nutrition (TPN) containing Mn at 20μmol (1.10 mg)/day for 63 days, due to a lack of improvement following hematoma aspiration surgery. Even 4 weeks after cessation of TPN, severe rigidity, akinetic mutism and other problems persisted. A characteristic pattern on T 1-weighted MRI, including an increased signal from the basal ganglia and deep white matter of both hemispheres, and elevated serum Mn levels, suggested Parkinson's syndrome due to Mn intoxication. Levodopa, Amantadine hydrochloride, and a chelating agent (calcium disodium edetate) effectively improved his conditions, including the rigidospasticity, akinesia, speech deficit, and ADL. After 3 months treatment with anti-Parkinsonism agents and hemiplegic rehabilitation, the patient regained the ability to walk and specific findings on MRI also disappeared. More attention should be paid to the extrapyramidal side-effects of long-term intravenous administration of Mn.
社団法人日本リハビリテーション医学会の論文
2000-10-18