Pathophysiology of parkinsonism due to hydrocephalus.
We report a patient with hydrocephalus who developed levodopa responsive parkinsonism and severe bradyphrenia associated with shunt malfunction and revision. Magnetic resonance imaging revealed periaqueductal edema involving medial substantia nigra. [18F]dopa positron emission tomography demonstrated reduced uptake in the caudate and putamen with relative sparing of the posterior putamen. Hydrocephalus associated with shunt malfunction can cause a distinct parkinsonian syndrome with greater dysfunction of projections from the medial substantia nigra to anterior striatum than in idiopathic Parkinson's disease.
Department of Neurology and Neurological Surgery (Neurology), Washington University School of Medicine, 660 South Euclid Ave, Box 8111, St. Louis, MO 63110, USA. racetteb@neuro.wustl.edu
B A
BA
Racette
G J
GJ
Esper
J
J
Antenor
K J
KJ
Black
A
A
Burkey
S M
SM
Moerlein
T O
TO
Videen
V
V
Kotagal
J G
JG
Ojemann
J S
JS
Perlmutter
D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001931:Brain Mapping; D002230:Carbidopa / Q000627:therapeutic use; D002421:Caudate Nucleus / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000503:physiopathology; D004338:Drug Combinations; D004868:Equipment Failure; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D018476:Hypokinesia / Q000188:drug therapy / Q000503:physiopathology; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D020734:Parkinsonian Disorders / Q000188:drug therapy / Q000503:physiopathology*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology*; D011699:Putamen / Q000503:physiopathology; D017287:Ventriculoperitoneal Shunt
D000978:Antiparkinson Agents; D004338:Drug Combinations; D007980:Levodopa; D002230:Carbidopa