title: A coincidental case of young-onset Parkinson disease and multiple sclerosis.
abstract: BACKGROUND
  Parkinsonism in patients with multiple sclerosis is rare. Some patients have 2 coincidental diseases, whereas others have a Parkinsonian syndrome symptomatic to demyelinating lesions.
  
  
  METHODS
  We describe a 42-year-old female patient who developed left akinetic-rigid Parkinsonian syndrome at the age of 38 years. Brain magnetic resonance imaging revealed multiple white matter hyperintense T2-weighted lesions. DaTSCAN revealed reduced uptake of dopamine transporter in the right striatum. Intravenous corticosteroids were inefficacious. She had major clinical improvement with levodopa and 6 months later developed peak-dose dyskinesias. At the age of 41 years, she presented with a brainstem attack, with complete symptom resolution after intravenous corticosteroids. Subsequent brain magnetic resonance imagings disclosed new inflammatory lesions. Immunomodulatory treatment was started with β-interferon.
  
  
  CONCLUSIONS
  In this patient, the presence of an asymmetrical Parkinsonian syndrome, with good response to levodopa, peak-dose dyskinesias, and abnormal DaTSCAN, supports the diagnosis of young-onset Parkinson disease. The multiple sclerosis diagnosis was established based on clinical evidence of time and space dissemination of demyelinating lesions.
authors: Department of Neurology, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal. joanadamasio80@gmail.com
authors: Joana
authors: J
authors: Damásio
authors: Cristina
authors: C
authors: Ramos
authors: Leandro
authors: L
authors: Valdemar
authors: Ana Martins
authors: AM
authors: da Silva
authors: Marina
authors: M
authors: Magalhães
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D016899:Interferon-beta / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000473:pathology; D010300:Parkinson Disease / Q000134:cerebrospinal fluid / Q000150:complications* / Q000473:pathology
chemical_list: D016899:Interferon-beta