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A 48-year-old women was admitted to our hospital because of gradually developed spastic gait. She showed spasticity of the lower extremities with mild weakness. Laboratory tests disclosed decreased WBC and platelet counts and mild increases of transaminase and total bilirubin. Blood manganese level was markedly increased (6.0 micrograms/dl). Abdominal ultrasound showed splenomegaly, and abdominal angiography showed a dilatation of the portal and paraumbilical veins. T1-weighted MR images showed high signal intensities at the bilateral globus pallidus and cerebral peducles, and T2-weighted images showed high signal intensities at the bilateral deep white matter, posterior limbs of the internal capsule and right upper cervical spinal cord. Following the diagnosis of IPH, splenectomy was performed. The blood level of manganese decreased thereafter and her neurological deficits gradually improved. Hepatic diseases often show high signal intensities at the basal ganglia on T1-weighted images, and this seemed to be due to accumulation of manganese in our case. Because demyelination or axonal injury of the spinal cord are found in hepatic disease, we speculate that the high signal intensities at the spinal cord on T2-weighted images of our case reflect hepatic myelopathy, which may also be caused by high blood levels of manganese.

The serum trace elements aluminum (Al), zinc (Zn), nickel (Ni), and manganese (Mn), and creatinine clearance (Ccr) were measured in twenty normal volunteers and 40 patients; 5 patients had mild renal dysfunction, 10 patients had chronic renal failure 5 patients had uremia and 20 patients had been undergoing chronic hemodialysis. Serum Al, Cu, Zn, Ni and Mn were measured with a flameless atomic absorption spectrophotometer. Serum Al levels increased with decrement of the Ccr value. The serum Al level was abnormally high in chronic hemodialysis patients. The serum Cu level in the patients was similar to that in the healthy subjects. Serum Zn, Ni and Mn levels decreased with the decrement of the creatinine clearance level. These results suggest that measurement of serum Al, Zn, Ni and Mn levels can be used as an indication of renal function clinically. In conclusion, serum Al, Zn, Ni and Mn levels are clinical indicators of renal function.