title: Tardive parkinsonism in a bipolar patient: post-mortem examination supports a physiological rather than pathological dysfunction.
abstract: We describe a case of tardive parkinsonism in the setting of bipolar syndrome, and we offer pathological confirmation that idiopathic Parkinson disease was not the underlying etiology. A 74-year-old Hispanic woman with a history of bipolar disease was noted to have oro-buccal-lingual chorea and parkinsonian symptoms such as resting tremor, rigidity, bradykinesia, and gait disorder persisting several months after neuroleptic discontinuation. She had minor improvement in ambulation with levodopa treatment, and she significantly improved in ambulation only during her manic states. Examination of the subject's post-mortem brain revealed no explicit evidence of degeneration in substantia nigra or other brainstem centers, and no nigral or cortical Lewy bodies were present. Glial cytoplasmic inclusions (characteristic of multiple systems atrophy) and globose neurofibrillary tangles (seen in progressive supranuclear palsy) were not seen either. This patient's presentation was most consistent with neuroleptic-induced parkinsonism and tardive dyskinesia; the etiology was likely related to previous neuroleptic exposure.
authors.affiliation: Department of Neurology, Movement Disorders Center, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA.
authors.forename: Moon S
authors.initials: MS
authors.lastname: Won
authors.forename: Ania
authors.initials: A
authors.lastname: Mikos
authors.forename: Mary
authors.initials: M
authors.lastname: Hurd
authors.forename: Hubert
authors.initials: H
authors.lastname: Fernandez
authors.forename: Thomas
authors.initials: T
authors.lastname: Eskin
authors.forename: Janet
authors.initials: J
authors.lastname: Romrell
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects; D001714:Bipolar Disorder / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D010302:Parkinson Disease, Secondary / Q000139:chemically induced / Q000473:pathology*
chemical_list: D014150:Antipsychotic Agents