From the liver to the brain: manganese matters

Excerpt

In this issue, an original article by Maffeo and colleagues [1] deals with chronic acquired hepatocerebral degeneration (CAHD), a disorder linking cirrhosis to Parkinsonism through brain accumulation of manganese (Mn). The authors studied a population of 90 subjects with cirrhosis: 26 out of 90 showed MRI pallidal T1 hyperintense signal suggestive of Mn storage, 7 of whom had CAHD. A long-term neurological and neuroradiological follow up was performed, including evaluation of response to orthotopic liver transplantation (OLT). The study remarks three main concepts. First, cerebral accumulation of Mn is necessary but not sufficient for CAHD, and cannot be considered predictive of CAHD: indeed, brain MRI often reveals Mn storage in cirrhotic patients without neurological manifestations even at long-term follow up. Second, blood Mn levels do not seem to reflect brain Mn deposits. Third, OLT may lead to disappearance of CAHD and/or MRI pallidal T1 hyperintensity. …