title: Obstructive hydrocephalus-induced parkinsonism. I: Decreased basal ganglia regional blood flow.
abstract: A 17-year-old male developed acute parkinsonism after obstruction of a ventriculoperitoneal shunt with subsequent hydrocephalus. Following a previous shunt replacement, he developed florid parkinsonism which was associated with Parinaud syndrome. The initial single-photon emission computed tomography of the brain using 99mTc-hexamethylpropylenamine oxime demonstrated decreased cerebral blood flow in the regions of the left caudate and putamen. The patient underwent shunt revision with minimal improvement and therefore levodopa/carbidopa (Sinemet 100/25) was administered. Subsequently, he experienced almost complete recovery which may have been correlated with probable improvement of the basal ganglia regional cerebral blood flow. Parkinsonism associated with ventriculoperitoneal shunt obstruction is a rare but reversible disorder that is responsive to shunt replacement and antiparkinsonian drug administration. Cerebral perfusion studies may prove to be of value in delineating the pathophysiology of this complication.
authors.affiliation: Division of Neurology, Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Shahar
authors.forename: R
authors.initials: R
authors.lastname: Lambert
authors.forename: P A
authors.initials: PA
authors.lastname: Hwang
authors.forename: H J
authors.initials: HJ
authors.lastname: Hoffman
mesh_terms: D000293:Adolescent; D001479:Basal Ganglia / Q000098:blood supply*; D002230:Carbidopa / Q000627:therapeutic use; D002535:Cerebral Aqueduct / Q000503:physiopathology; D002557:Cerebrospinal Fluid Shunts; D004338:Drug Combinations / Q000627:therapeutic use; D006801:Humans; D006849:Hydrocephalus / Q000503:physiopathology / Q000601:surgery*; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D009942:Organometallic Compounds; D010091:Oximes; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology*; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000187:drug effects; D019690:Technetium Tc 99m Exametazime; D014055:Tomography, Emission-Computed
chemical_list: D004338:Drug Combinations; D009942:Organometallic Compounds; D010091:Oximes; C009265:carbidopa, levodopa drug combination; D019690:Technetium Tc 99m Exametazime; D007980:Levodopa; D002230:Carbidopa