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Paraparesis, hypermanganesaemia, and polycythaemia: a novel presentation of cirrhosis
  1. S M Gospe Jra,
  2. R D Carusoa,
  3. M S Clegga,
  4. C L Keena,
  5. N R Pimstonea,
  6. J M Ducorea,
  7. S S Gettnerb,
  8. R A Kreutzerb
  1. aDepartments of Neurology, Pediatrics, Radiology, Nutrition, and Internal Medicine, University of California, Davis, California, USA, bEnvironmental Health Investigations Branch, California Department of Health Services, Oakland, California, USA
  1. Dr S M Gospe Jr, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Neurology, CH-49, Seattle, WA 98105, USA email:sgospe{at}


Progressive myelopathy is a rare complication of chronic hepatic disease which has never been reported in the paediatric age group. We describe the 11 year course of an adolescent male with hepatic myelopathy caused by cryptogenic micronodular cirrhosis. His condition has been associated with persistent polycythaemia and extraordinary increases of whole blood manganese, with magnetic resonance imaging evidence of manganese deposition within the basal ganglia and other regions of the brain. The patient has developed neither liver failure nor parkinsonism. The pathophysiological bases of this multiorgan system disorder are described.

  • hepatic myelopathy
  • manganese
  • neurotoxicity
  • erythropoietin

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