Annals of Occupational and Environmental Medicine

Case Report

Three Cases of High Signal Intensity by Brain Magnetic Resonance Imaging in CO2 arc Welders: Young Seoub Hong, Myung Ah Lim, Yong Hee Lee, Hae Kwan Cheong, Ji Yong Kim, Hyun Sul Lim, Jung Jeung Lee, Kong Joon Sa, Joon Youn Kim; Korean Journal of Occupational and Environmental Medicine 1998;10(2):290-298. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.290

We experienced three cases of high signal intensity observed by Brain Magnetic Resonance Imaging in CO2 arc welders of steel-frame manufacturing industry. Case 1 was a 35 years old man who has been an CO2 arc welder for 10 years, admitted a sudden onset of tonic clonic seizure. He complained fever, chilling and myalgia since 3 days before admission. On admission, in the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.17 microgram/dL, 22.00 microgram/l and 31.25 ppm respectively. Case 2 was a 35 years old man who has been an CO2 arc welder for 20 years. On admission, He complained fatigue, numbness and weakness of extremities, and decrease of libido. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 6.34 microgram/dL, 14.62 microgram/l and 57.87 ppm respectively. In neurologic examination, Palmo-mentis reflex and Myerson sign were observed. Case 3 was a 33 years old man who has been an CO2 arc welder for 16 years. On admission, He complainer loss of appetite, numbness of extremities, fatigue and decrease of attention. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.14 microgram/dL, 13.79 microgram/l and 50.08 ppm respectively. In neurologic examination, Myerson sign was observed. In brain magnetic resonance imaging, T1WI showed symmetrical high signal intensity in basal ganglia and midbrain of three cases. Authors argued that they were developed by manganese exposure, and we considered that follow up study would be necessary.

Citations

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A Study on the Total, Particle Size-Selective Mass Concentration of Airborne Manganese, and Blood Manganese Concentration of Welders in a Shipbuilding Yard
Jong Su Park, Pan Gyi Kim, Jee Yeon Jeong
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(4): 472. CrossRef
Occupational Diseases in Korea
Seong-Kyu Kang, Eun A Kim
Journal of Korean Medical Science.2010; 25(Suppl): S4. CrossRef
Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef

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Original Article

An Association between Brain MRI and Neurologic Findings in Welders Exposed to Manganese Fume: Hyeon Woo Yim, Ji Hong Kim, Young Gyu Phee, Jung Wan Koo, Kang Sook Lee, Chung Yill Park, Jeong Wook Lee, Si Ryung Han, Hye Suk Jang; Korean Journal of Occupational and Environmental Medicine 1998;10(2):161-171. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.161

Abstract PDF

This study was carried out to investigate the relationship between brain magnetic resonance imaging (MRI) and neurological findings in welders exposed to manganese fume. Thirty five welders from a bus manufacturing factory who were occupationally exposed to low dose manganese fume were examined. We collected the information on the demo graphic factors and welding careers. Laboratory investigations included blood and urine manganese concentration and blood chemistry. Brain MRI was checked, and high signal intensity of the globus pallidus was graded from 0 to 3 compared to the white matter of the frontal lobe. Neurologic examination wart carried out. The results were as follows ; 1. The mean age of workers was 48.3+/-5.7 years, mean duration of welding was 21.4 +/-5.6 Years. 2. On brain MRI, high signal intensity in the globes pallidus was observed in 27 workers (77.1%) Among them, 18 cases (66.7%) showed remarkably high signal intensity (grade 2) Mean concentration of blood manganese was higher in those with high signal intensity and correlated to the grade of high signal intensity (p=0.02) 3. On neurologic examination, no workers showed the finding of typical parkinsonism. But 11 workers (31.4%) showed subtle neurological abnormalities such as gait without associated arm movement, postural instability, intention tremor, and so on. Blood manganese concentration of neurologically abnormal group was 2.4+/-0.7 microgram/dL, which was significantly higher, compared to 1.8+/-0.7 microgram/dL of neurologically normal group (p=0.03). 4. Among 27 workers who showed high signal intensity on brain MRI, 10 workers (37%) were neurologically abnormal. Higher grade of signal intensity on globus pallidus showed higher rate of neurologic abnormality (p<0.05) Especially postural instability and gait without associated arm movement were prominent findings. These bindings suggest that high signal intensity on brain MRI might be associated with a prodromal sign of manganese intoxication. Careful neurologic examination should be tool lowed up on welders showing high signal intensity in the golbus pallidus of brain MRI.

Citations

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Annals of Occupational and Environmental Medicine.2021;[Epub] CrossRef
Association of MRI T1 relaxation time with neuropsychological test performance in manganese- exposed welders
R.M. Bowler, C-L. Yeh, S.W. Adams, E.J. Ward, R.E. Ma, S. Dharmadhikari, S.A. Snyder, S.E. Zauber, C.W. Wright, U. Dydak
NeuroToxicology.2018; 64: 19. CrossRef
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Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef
State-of-the-Science Review: Does Manganese Exposure During Welding Pose a Neurological Risk?
Annette B. Santamaria, Colleen A. Cushing, James M. Antonini, Brent L. Finley, Fionna S. Mowat
Journal of Toxicology and Environmental Health, Part B.2007; 10(6): 417. CrossRef
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NeuroToxicology.2007; 28(2): 298. CrossRef

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