[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-437979-105":59,"doc-detail-437979-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","a-rare-case-of-brain-manifestation-of-manganese-toxicity-and-its-management-a-case-report-and-literature-review","A Rare Case of Brain Manifestation of Manganese Toxicity and Its Management - A Case Report and Literature Review","","Manganese (Mn) toxicity is a rare and challenging disorder to diagnose because its neurological symptoms are often nonspecific. Chronic liver disease creates a distinctive risk pattern, with Mn deposition in the brain and preferential accumulation in the basal ganglia affecting dopamine-producing neurons. A case of a five-year-old Asian male with chronic liver disease is presented, describing neurological manifestations and response to chelation therapy that reduces Mn deposition. The report reviews diagnostic difficulty, clinical significance, and interdisciplinary management for better outcomes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-rare-case-of-brain-manifestation-of-manganese-toxicity-and-its-management-a-case-report-and-literature-review/437979/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-rare-case-of-brain-manifestation-of-manganese-toxicity-and-its-management-a-case-report-and-literature-review/437979.png","ImageObject",300,407,{"name":92,"@type":93},"pop out","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is manganese (Mn) toxicity difficult to diagnose in clinical practice?","Question",{"text":113,"@type":114},"Mn toxicity has unusual and often nonspecific neurological presentations, which can obscure early recognition. In this context, the association with chronic liver disease is key to raising clinical suspicion.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What brain region does manganese preferentially accumulate in, according to the case report?",{"text":118,"@type":114},"The report describes a tendency for preferential accumulation in the basal ganglia, specifically targeting dopamine-producing (DAergic) neurons. Imaging findings are noted as supportive of Mn deposition.",{"name":120,"@type":111,"acceptedAnswer":121},"How did chelation therapy affect the patient in this case?",{"text":122,"@type":114},"Chelating therapy reduced Mn deposition in the brain, and the child’s response to interventions is highlighted as important. The report emphasizes early recognition and comprehensive management to improve outcomes and reduce irreversible sequelae.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},437979,1790973609,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962090760408,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Review began 11/24/2025  \nReview ended 12/01/2025  \nPublished 12/06/2025  \n© Copyright 2025  \nPatel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98567  \nOpen Access Case Report  \nA Rare Case of Brain Manifestation of Manganese Toxicity and Its Management: A Case Report and Literature Review  \nMaulinkumar N. Patel 1, Aastha Arunkumar Patel 2, Chandan Alenahalli Narayana 3 , Rutuja Tere 4, Dhruvil Vinaybhai Patel 2, Saniah Khan 5, Zenia Elavia 6, Mansi Singh 7  \n1. Epidemiology and Biostatistics, The University of Texas Health Science Center at Houston, Houston, USA 2. Internal Medicine, GMERS Medical College and Hospital, Gandhinagar, Gandhinagar, IND 3. College of Medicine, Bangalore Medical College and Research Institute, Bengaluru, IND 4. Internal Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND 5. Internal Medicine, King Edward Medical University, Lahore, PAK 6. College of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND 7. Medicine, Bogomolets National Medical University, Kyiv, UKR  \nCorresponding author: Mansi Singh, [singhmansi57@gmail.com](singhmansi57@gmail.com)  \nAbstract  \nManganese (Mn) toxicity is a rare but perplexing condition, often difficult to diagnose due to its unusual clinical presentation. Mn toxicity 's neurological symptoms can be nonspecific, making early diagnosis crucial. The unique association between chronic liver disease and Mn toxicity highlights the need for increased clinical awareness and further research. We present a case of a five-year-old Asian male child with chronic liver disease who presented with neurological symptoms due to brain Mn deposition and its management. Notably, Mn exhibits a propensity for preferential accumulation in the basal ganglia, specifically targeting dopamine-producing (DAergic) neurons. The child 's response to interventions, including a reduction in Mn deposition in the brain using chelating therapy, underscores the significance of early recognition and comprehensive management in addressing this condition. This case report delves into an exceptional instance of Mn toxicity, emphasizing the significance of early recognition and interdisciplinary intervention.  \nCategories: Neurology, Psychiatry, Internal Medicine  \nKeywords: acute on chronic liver disease, confabulation, continuous chelation, globus pallidus lesions, manganese toxicity  \nIntroduction  \nManganese (Mn), the fifth most abundant metal and 12th overall in the earth’s crust, is an essential trace element vital for enzymatic and metabolic processes in humans, with dietary intake typically meeting daily requirements [1,2] . However, excessive Mn can cause neurotoxicity, particularly in individuals with impaired biliary excretion, such as those with chronic liver disease [3,4] . Accumulation may result from defective transporter function, environmental exposure (air, water, food), or total parenteral nutrition (TPN) [3] . In liver dysfunction, Mn deposition in the basal ganglia can lead to acquired hepatocerebral degeneration, affecting 1-2% of cases and causing Parkinsonism, dystonia, ataxia, and cognitive deficits [4] . Pediatric cases, though rare, are reported in cholestatic disorders, presenting with developmental delays, hyperactivity, and motor impairments, often exacerbated by TPN or genetic mutations like SLC30A 10, which increase hypermanganesemia risk [3-5].  \nThis report presents a rare case of Mn neurotoxicity in a five-year-old boy with chronic liver disease, highlighting the need for early recognition and multidisciplinary management. Characteristic imaging findings, such as bilateral, symmetrical T 1 hyperintensities in the globus pallidus and anterior midbrain, suggested Mn deposition, alig","cbCaie6wlU3yIryf","https://ap.wps.com/l/cbCaie6wlU3yIryf","pdf",517426,"English","# Abstract\n# Introduction\n# Case Presentation","[{\"question\":\"Why is manganese (Mn) toxicity difficult to diagnose in clinical practice?\",\"answer\":\"Mn toxicity has unusual and often nonspecific neurological presentations, which can obscure early recognition. In this context, the association with chronic liver disease is key to raising clinical suspicion.\"},{\"question\":\"What brain region does manganese preferentially accumulate in, according to the case report?\",\"answer\":\"The report describes a tendency for preferential accumulation in the basal ganglia, specifically targeting dopamine-producing (DAergic) neurons. Imaging findings are noted as supportive of Mn deposition.\"},{\"question\":\"How did chelation therapy affect the patient in this case?\",\"answer\":\"Chelating therapy reduced Mn deposition in the brain, and the child’s response to interventions is highlighted as important. The report emphasizes early recognition and comprehensive management to improve outcomes and reduce irreversible sequelae.\"}]","A Rare Case of Brain Manifestation of Manganese Toxicity and Its Management - A Case Report and Literature Review | PDF",1790683706,13]