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Portal-systemic shunts, manganese, and parkinsonism

¹ Division of Neurology, Hospital A Marcide, Estrada San Pedro-Catabois s/n, 15405 Ferrol, A Coruña, Spain

Correspondence to:
Correspondence to:
Dr Raúl de la Fuente-Fernández
rfuente@medynet.com

Keywords: portal-systemic shunt; manganese; parkinsonism

The first 150 words of the full text of this article appear below.

I read with interest the article by Yoshikawa and colleagues.¹ The authors reported the case of a 44 year old woman with hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease) involving the liver, who had raised serum concentrations of manganese, hyperintense areas in the basal ganglia on T1 weighted magnetic resonance images, and levodopa unresponsive parkinsonism. Naturally, I agree that the parkinsonism in this case is most probably related to portal-systemic (portal-venous) shunts. There are, however, two points that deserve clarification.

First, it is not entirely clear whether their fig 2 (left panel) shows portal-systemic or arteriovenous shunts. The authors say that the figure shows a selective angiogram of the superior mesenteric artery. If that were the case, there should not be a "feeding artery" involved in the intrahepatic shunts (as they state in the legend to fig 2). Instead, the figure would show the portal vein and portal-systemic shunts (that is, portal . . . [Full text of this article]

K Yoshikawa², M Nakagawa²

² Department of Neurology, Research Institute for Neurological Diseases and Geriatrics, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan

Correspondence to:
Correspondence to:
Dr K Yoshikawa
kyoshika@koto.kpu-m.ac.jp