Gliomatosis cerebri presenting as a parkinsonian syndrome

We report a 70-year-old man who was hospitalized after a left-sided partial seizure progressed to grand mal seizures. Three years before, the patient had presented with the main symptoms of bradykinesia and gait disturbance and was diagnosed with parkinsonism resistant to L-dopa. At the latest admission, extensive diffuse white matter high-intensity areas were present on T2-weighted magnetic resonance imaging images, and stereotactic brain biopsy showed that these lesions were gliomatosis cerebri (GC). This is the first reported case in which extensive lesions in the bilateral white matter have been associated with parkinsonism as the main clinical feature; only one other case has been reported in which GC presented as parkinsonism, and this differed from the current case with respect to localization and symptoms. We speculate that damage to the thalamocortical projections and functional impairment due to demyelination could have caused parkinsonism in our patient, and we discuss the differential diagnosis.