Dopamine Transporter SPECT of a Liver Cirrhotic with Atypical Parkinsonism

High level of exposure to manganese (Mn) can cause a clinically and pathophysiologically distinct syndrome from idiopathic Parkinson's disease (PD). We describe the clinical features and results of ( 123 I)-fluoropropyl (FP)-CIT SPECT of a liver cirrhotic with atypical parkinsonism. The patient developed atypical parkinsonian features associated with elevated blood Mn from hepatic dysfunction. ( 123 I)-FP-CIT brain SPECT images of dopamine transporter (DAT) demonstrated overall normal range of DAT uptake in the striatum although there were scattered small hypodense regions. The globus pallidum had increased signal on T1-weighted magnetic resonance imaging (MRI). All these findings are compatible with those of manganism, and are remarkably different from that in PD.