title: Parkinsonism after external ventricular drainage in a patient with intraventricular hemorrhage.
abstract: We report a patient who presented with Parkinsonism after external ventricular drainage (EVD) for an intraventricular hemorrhage (IVH). We also demonstrate dopaminergic system dysfunction using (18)F-florinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-(4-lodophenyl) nortropane ((18)F-FP-CIT) positron emission tomography (PET) scanning. A 50-year-old woman presented with manifestations of Parkinsonism, including severe rigidity and 3-Hz resting tremor, immediately after EVD for IVH. (18)F-FP-CIT PET images at 6 months after onset showed dysfunction of the bilateral caudate nuclei and putamen after EVD that seemed to have induced Parkinsonism, although no lesion was observed in those areas on either conventional computed tomography or magnetic resonance imaging. With a dose of 300/1200 mg/day carbidopa/levodopa, the rigidity of both upper and lower extremities was significantly reduced, and the tremor completely disappeared. The decreased rigidity also improved the activities of daily living performance. In summary, a patient developed Parkinsonism after EVD for IVH, and we demonstrated dopaminergic system dysfunction on (18)F-FP-CIT PET images. Clinicians should pay particular attention to the occurrence of Parkinsonism when performing procedures that can reduce intraventricular pressure.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Min Ho
authors.initials: MH
authors.lastname: Chun
authors.affiliation: Department of Physical Medicine and Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Chang Gu
authors.initials: CG
authors.lastname: Kang
authors.affiliation: Department of Nuclear Medicine, University of Yeungnam College of Medicine, Taegu, Republic of Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Kong
authors.affiliation: Department of Physical Medicine and Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: wheel633@hanmail.net.
authors.forename: Min Cheol
authors.initials: MC
authors.lastname: Chang
mesh_terms: D000203:Activities of Daily Living; D002230:Carbidopa / Q000627:therapeutic use; D002421:Caudate Nucleus / Q000000981:diagnostic imaging / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000098:blood supply*; D004322:Drainage / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000601:surgery*; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010302:Parkinson Disease, Secondary / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011699:Putamen / Q000000981:diagnostic imaging / Q000503:physiopathology; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014326:Tropanes; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
chemical_list: D004338:Drug Combinations; D019275:Radiopharmaceuticals; D014326:Tropanes; C009265:carbidopa, levodopa drug combination; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane; D007980:Levodopa; D002230:Carbidopa
keywords: (18)F-FP-CIT; Parkinsonism; external ventricular drainage; intraventricular hemorrhage; positron emission tomography