TY - JOUR
T1 - Teaching Video NeuroImage
T2 - Reversible Parkinsonism Caused by Lumboperitoneal Shunt Overdrainage
AU - Takeuchi, Hajime
AU - Masaki, Katsuhisa
AU - Ogata, Hidenori
AU - Nagata, Satoshi
AU - Shimogawa, Takafumi
AU - Yamasaki, Ryo
AU - Isobe, Noriko
N1 - Publisher Copyright:
© 2022 American Academy of Neurology.
PY - 2022/9/13
Y1 - 2022/9/13
N2 - A 51-year-old woman presented with apraxia of eyelid opening, followed by slowly progressive masked facies, tongue tremor, dysphagia, neck and upper extremity rigidity, and bradykinesia 6 months after lumboperitoneal shunt placement for hydrocephalus after subarachnoid hemorrhage. An MRI examination of the brain showed midbrain compression, brainstem displacement inferiorly, and cistern effacement, consistent with infratentorial hypotension. 123I-ioflupane SPECT imaging showed reduced striatal dopamine transporter binding bilaterally. All symptoms and findings ameliorated after increasing shunt pressure (Figures 1 and 2 and Video 1). UPDRS Part III score improved from 24 to 5. Intracranial hypotension with midbrain sagging can cause reversible parkinsonism1,2 when displacement shear forces impair the nigrostriatal dopamine pathway.
AB - A 51-year-old woman presented with apraxia of eyelid opening, followed by slowly progressive masked facies, tongue tremor, dysphagia, neck and upper extremity rigidity, and bradykinesia 6 months after lumboperitoneal shunt placement for hydrocephalus after subarachnoid hemorrhage. An MRI examination of the brain showed midbrain compression, brainstem displacement inferiorly, and cistern effacement, consistent with infratentorial hypotension. 123I-ioflupane SPECT imaging showed reduced striatal dopamine transporter binding bilaterally. All symptoms and findings ameliorated after increasing shunt pressure (Figures 1 and 2 and Video 1). UPDRS Part III score improved from 24 to 5. Intracranial hypotension with midbrain sagging can cause reversible parkinsonism1,2 when displacement shear forces impair the nigrostriatal dopamine pathway.
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U2 - 10.1212/WNL.0000000000200994
DO - 10.1212/WNL.0000000000200994
M3 - Article
C2 - 35803719
AN - SCOPUS:85139739333
SN - 0028-3878
VL - 99
SP - 486
EP - 488
JO - Neurology
JF - Neurology
IS - 11
ER -