Isr Med Assoc J
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Manganism is a central nervous system disorder caused by toxic exposure to manganese. Manganism has been related to occupational exposures, liver diseases, prolonged parenteral nutrition, and abuse of illicit drugs. Initially manifested by a reversible neuropsychiatric syndrome (locura manganica), the main symptoms and signs of manganism are emotional lability, compulsive behavior and visual hallucinations. Locura manganica is followed by an irreversible extrapyramidal syndrome, the onset of which occurs years after chronic exposure. ⋯ Prominent Mn depositions, evidenced by T1-weighted hyperintensities in the hippocampus after subacute exposure to Mn, are compatible with the clinical picture of manganism during its early stages, and may explain its pathophysiology.
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Clinicians' impression of adolescents' alcohol or drug involvement may underestimate substance-related pathology. ⋯ The likelihood of substance abuse is higher in patients presenting with a low level of consciousness, Physicians may accurately assess the likelihood of substance abuse in these patients.