Hepatic Dysfunction and Neuropsychiatric Sequelae Through Manganese Toxicity

Manganese is an essential trace element necessary for various physiological functions, but excessive exposure or impaired elimination can result in neurotoxicity. We report a 50-year-old patient with chronic liver disease and worsening confusions, who on imaging was shown to have T1-hyperintensities in the globi pallidi consistent with manganese accumulation. However, the patient did not demonstrate Parkinsonian features raising the possibility of a biphasic presentation in which neuropsychiatric symptoms precede motor deficits. This case underscores the importance of recognizing manganese neurotoxicity as a potential contributor to neuropsychiatric symptoms in patients with hepatic dysfunction.