Neurologic manifestations in welders with pallidal MRI T1 hyperintensity
Neurologic manifestations in welders with pallidal MRI T1 hyperintensity
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DOI：
10.1212/01.wnl.0000167411.93483.a1
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发表时间：
2005-06-28
期刊：
影响因子：
9.9
通讯作者：
Cowl, CT
中科院分区：
文献类型：
--
作者：
Josephs, KA;Ahlskog, JE;Cowl, CT
背景：神经系统症状归因于焊接过程中产生的锰烟雾。基底神经节T1 MRI信号增加是锰蓄积的生物学标志。最近的研究将焊接和帕金森综合征联系起来，但通常没有MRI证实。目的：描述MRI基底节T1高信号患者的临床和神经心理学特征，这些患者最终被诊断为焊接烟雾神经毒性。研究方法：回顾了因神经系统问题和基底节T1高信号而转诊至神经内科的焊工的病历。结果：8例患者均为男性职业焊工，MRI显示基底节T1信号增高。几种不同的临床综合征被确认：帕金森综合征（3例），多灶性肌阵挛和有限的认知功能障碍综合征（2例），前庭听觉功能障碍的混合综合征（2例），和轻微的主观认知功能障碍，焦虑和睡眠呼吸暂停（1例）。神经心理测试提示皮质下或额叶受累。焊接过程中通风不足或缺乏个人呼吸保护是一个常见的问题。结论：没有适当保护的焊接与帕金森综合征、多灶性肌阵挛、轻度认知障碍和前庭听觉功能障碍有关。基底神经节的MRI T1高信号表明这些可能是由锰神经毒性引起的。
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.