Manganese Neurotoxicity as a Complication of Chronic Total Parenteral Nutrition

Figure 1

Axial T1-weighted MRI brain performed serially over three months, showing the progression of the T1 hyperintensities in the globus pallidi from June 2018 to July 2018, followed by the improvement of the T1 hyperintensities in August 2018, one month after discontinuation of TPN. (a) Evidence of developing T1 hyperintensities in the bilateral globus pallidi on a previous hospital admission in June 2018. (b) Further increase in signal in the bilateral globus pallidi on T1-weighted images in July 2018, corresponding to her pronounced Parkinsonian features on clinical presentation. (c) Improvement in the T1 hyperintensities in the globus pallidi, collected one month after cessation of TPN use and corresponding to near-resolution of her Parkinsonism.

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