An 85-year old male with levodopa-responsive parkinsonism followed by dementia and supranuclear ophthalmoplegia caused by alzheimer-type pathology without Lewy bodies.
An 85-year-old man developed l-dopa responsive parkinsonism indistinguishable from Parkinson's disease and subsequent dementia, followed by supranuclear ophthalmoplegia and neck dorsiflexion at the terminal stage. Midbrain tegmentum and medial temporal lobe were atrophic on magnetic resonance imaging, while decreased blood flow was predominant in frontotemporal lobes, detected by 3D-SSP of 123I- IMP SPECT. Alzheimer-type pathology without Lewy body pathology was confirmed at autopsy. Substantia nigra showed mild degeneration and several neurofibrillary tangles without Lewy body pathology or progressive supranuclear palsy cytopathology. L-dopa responsive parkinsonism could be an initial manifestation of Alzheimer's disease, which should be included in the differential diagnosis.
Department of Medicine, Division of Neurology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Naoki
N
Kasahata
Department of Medicine, Division of Neurology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan.
Mariko
M
Hagiwara
Department of Laboratory Medicine, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan.
Hiroyuki
H
Kato
Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Ayako
A
Nakamura
Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Toshiki
T
Uchihara
D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000000981:diagnostic imaging; D000661:Amphetamine; D003704:Dementia / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D020734:Parkinsonian Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D019275:Radiopharmaceuticals; D013494:Supranuclear Palsy, Progressive / Q000150:complications* / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D007980:Levodopa; D000661:Amphetamine
3-iodobenzylguanidine; Alzheimer's disease; Lewy bodies; Parkinsonian disorders; Tegmentum mesencephali; levodopa; progressive supranuclear palsy