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.
Racette
B A
BA
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
Esper
G J
GJ
Antenor
J
J
Black
K J
KJ
Burkey
A
A
Moerlein
S M
SM
Videen
T O
TO
Kotagal
V
V
Ojemann
J G
JG
Perlmutter
J S
JS
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