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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 64, Number 12, June 28, 2005 Data Supplement All Versions of this Article: 01.WNL.0000167411.93483.A1v1 64/12/2033    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Josephs, K. A. Articles by Cowl, C. T. Search for Related Content PubMed PubMed Citation Articles by Josephs, K. A. Articles by Cowl, C. T. Related Collections MRI Parkinson's disease/Parkinsonism All Toxicology

Neurologic manifestations in welders with pallidal MRI T1 hyperintensity

From the Departments of Neurology (Drs. Josephs, Ahlskog, Klos, Kumar, and Fealey) and Psychiatry (Neuropsychology) (Dr. Trenerry) and Division of Preventive and Occupational Medicine (Dr. Cowl), Mayo Clinic, Rochester, MN.

Address correspondence and reprint requests to Dr. K.A Josephs, Department of Neurology, Divisions of Behavioral Neurology and Movement Disorders, Mayo Clinic, Rochester, MN 55905; e-mail: josephs.keith{at}mayo.edu

Background: Neurologic symptoms have been attributed to manganese fumes generated during welding. Increased T1 MRI signal in the basal ganglia is a biologic marker of manganese accumulation. Recent studies have associated welding and parkinsonism, but generally without MRI corroboration.

Objective: To characterize the clinical and neuropsychological features of patients with MRI basal ganglia T1 hyperintensity, who were ultimately diagnosed with neurotoxicity from welding fumes.

Methods: The medical records of welders referred to the Department of Neurology with neurologic problems and basal ganglia T1 hyperintensity were reviewed.

Results: All eight patients were male career welders with increased T1 basal ganglia signal on MRI of the brain. Several different clinical syndromes were recognized: a parkinsonian syndrome (three patients), a syndrome of multifocal myoclonus and limited cognitive impairment (two patients), a mixed syndrome with vestibular–auditory dysfunction (two patients), and minor subjective cognitive impairment, anxiety, and sleep apnea (one patient). Neuropsychometric testing suggested subcortical or frontal involvement. Inadequate ventilation or lack of personal respiratory protection during welding was a common theme.

Conclusions: Welding without proper protection was associated with syndromes of parkinsonism, multifocal myoclonus, mild cognitive impairment, and vestibular–auditory dysfunction. The MRI T1 hyperintensity in the basal ganglia suggests that these may have been caused by manganese neurotoxicity.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 28 issue to find the title link for this article.

Received October 21, 2004. Accepted in final form March 3, 2005.

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