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Hemiparkinsonism caused by a lateral sphenoid wing meningioma, with tractography analysis: illustrative case
Attill Saemann1, Stefan Busch1, Ethan Taub1
1Departments of1Neurosurgery.
Background:
The etiologies of parkinsonism are diverse. A possible and rare cause of hemiparkinsonism is mechanical compression of the basal ganglia and its connecting white matter tracts. The authors present a case of hemiparkinsonism caused by a lateral sphenoid wing meningioma, discuss the underlying pathophysiology based on tractography, and systematically review the existing literature.
Observations:
A 59-year-old female was referred for a left-sided tremor of the hand, accompanied by a cogwheel rigidity of the left arm. Symptomatology appeared 1 year earlier and worsened in the previous 6 months, finally also showing involvement of the left leg. Magnetic resonance imaging (MRI) showed a space-occupying suspected meningioma originating from the right lateral sphenoid wing and compressing the ipsilateral striatum. Tractography studies contributed to elucidate the underlying pathophysiology. Resection of the meningioma could be performed without complications. At the 4-month follow-up, the patient's hemiparkinsonism had completely recovered.
Lessons:
An intracranial space-occupying lesion may be a rare cause of hemiparkinsonism. In new-onset parkinsonism, especially if a secondary form is suspected, brain MRI should be performed promptly to avoid misdiagnosis and treatment. Tractography studies help understand the underlying pathophysiology. After surgical decompression of the affected structures, symptoms can recover completely.
Insights
A rare lateral sphenoid wing meningioma caused hemiparkinsonism by compressing the basal ganglia. Surgical removal of the tumor led to complete symptom recovery, highlighting the importance of brain MRI for diagnosing secondary parkinsonism.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Parkinsonism has diverse etiologies, with mechanical compression of basal ganglia being a rare cause of hemiparkinsonism.
- Lateral sphenoid wing meningiomas can present as space-occupying lesions affecting neurological function.
- Understanding the pathophysiology of secondary parkinsonism is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To present a case of hemiparkinsonism caused by a lateral sphenoid wing meningioma.
- To elucidate the pathophysiology using tractography.
- To review the literature on intracranial space-occupying lesions causing hemiparkinsonism.
Main Methods:
- Case presentation of a 59-year-old female with left-sided hemiparkinsonism.
- Magnetic resonance imaging (MRI) to identify a right lateral sphenoid wing meningioma compressing the ipsilateral striatum.
- Tractography studies to understand the affected white matter tracts.
- Surgical resection of the meningioma.
Main Results:
- The meningioma was successfully resected without complications.
- At 4-month follow-up, the patient experienced complete recovery from hemiparkinsonism.
- Tractography aided in understanding the compression's impact on basal ganglia pathways.
Conclusions:
- Intracranial space-occupying lesions, like meningiomas, are a rare but treatable cause of hemiparkinsonism.
- Prompt brain MRI is essential for diagnosing new-onset parkinsonism, especially secondary forms.
- Surgical decompression can lead to complete symptom resolution in such cases.
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