potassium-permanganate and Parkinsonian-Disorders

Chronic overexposure to manganese (Mn) may cause neuronal degeneration. Manganese intoxication is well known to induce parkinsonism. Manganese intoxication may be associated with abnormal magnetic resonance (MR) imaging (abnormal signal hyperintensity in the globus pallidus and substantia nigra on T1-weighted images).. We report an unusual presentation of manganese intoxication due to administration of a combination of acetylsalicylic acid and ephedrine HCl, potassium permanganate, and vinegar melted in tap water and administered parenterally as a psychostimulant substance in 2 cases who developed symptoms resembling parkinsonism. Neurologic examination of both cases revealed disturbances of the extrapyramidal system and a characteristic "cock walk." Tremor was present in the first case, whereas it was lacking in the second one. Cranial MRI showed bilateral symmetric T1-weighted hyperintense patterns in the globus pallidus, probably because of manganese accumulation. Different levels of response to levodopa were reported in the literature; in our cases, there was no response to levodopa.. Chronic overexposure to manganese may cause an atypical form of parkinsonism associated with increased T1 signal in the basal ganglia on magnetic resonance imaging.

Topics: Acetic Acid; Adult; Aspirin; Brain; Central Nervous System Stimulants; Drug Interactions; Ephedrine; Gait Disorders, Neurologic; Globus Pallidus; Humans; Injections, Intravenous; Magnetic Resonance Imaging; Male; Manganese Poisoning; Parkinsonian Disorders; Potassium Permanganate; Self Administration

Parkinsonian syndrome related to intravenous use of a "designer" psychostimulant, derived from pseudoephedrine using potassium permanganate as the oxidant, has been observed in drug addicts in Estonia.. To describe the symptomatology of four young patients, history of drug administration and chemical analysis of a drug batch.. Mental and motor function and quality of life were scored and ephedrone was analyzed using electrospray mass spectrometry. Manganese content of the final synthetic mixture was analyzed using Inductively Coupled Plasma-Atomic Emission Spectrometry.. None of the four cases scored below the dementia threshold in MMSE, while other ratings (UPDRS, H&Y, PDQ-39) corresponded to disabilities seen in relatively advanced Parkinson's disease. The ephedrone yield of the reaction was approximately 44% and the mixture was found to contain 0.6 g/l of manganese.. The cases were exposed to extreme manganese load. Their symptomatology is probably identical to manganism. The role of ephedrone is presently unknown. Physicians must be aware of early signs of manganism in patients within social risk groups.

Topics: Adult; Brain; Central Nervous System Stimulants; Disability Evaluation; Disease Progression; Dyskinesia, Drug-Induced; Ephedrine; Humans; Male; Manganese Poisoning; Mass Spectrometry; Neuropsychological Tests; Parkinsonian Disorders; Potassium Permanganate; Propiophenones; Substance-Related Disorders; Sweden