There is some evidence that acute exposures to fumes in the steel industry are associated with an atypical parkinsonian syndrome (79-81). The primary exposure in the steel industry is manganese. Wang et al. (81) described an outbreak of parkinsonism in a Taiwanese (Republic of China) ferromanganese smelter due to a defective ventilation control system. Of those subjects with brief, high-level exposure to inhaled manganese (>28.8 mg/m3) six of eight subjects developed parkinsonism. Symptoms of affected individuals included bradykinesia, rigidity, gait abnormalities, and tremor. Only one subject developed a "cock gait," a dystonic gait disorder reportedly characteristic of manganese exposure (82). No details on disease asymmetry or characteristics of tremor were reported, but subjects were noted to experience 50% improvement in parkinsonism with levodopa (81). Follow-up assessment demonstrated disease progression at five years in four subjects.
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