Transcranial Sonography in Manganese-Induced Parkinsonism Caused by Drug Abuse

Introduction: Transcranial sonography (TCS) is suitable to detect the accumulation of trace metals in the basal ganglia [1], and may be useful as a simple and safe technique in many neurodegenerative diseases [2-4]. Although the exact nature of basal ganglia hyperechogenicity is unclear, many studies have demonstrated an association between hyperechogenicity and iron accumulation [5]. In addition to iron, TCS hyperechogenicity has been associated with other trace metals, like copper and manganese [1]. Manganese accumulation in the brain can be caused by exposure to aerosolized manganese, as in miners and welders [6]. Manganese intoxication has also been described in cases of intravenous methcathinone (ephedrone) abuse. Homemade ephedrone is produced from tablets containing pseudoephedrine. The pseudoephedrine is oxidized with potassium permanganate, and then the solution is usually administered intravenously [7]. T1-weighted magnetic resonance imaging (MRI) hyperintensity in the basal gan ...