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Published on: October 4, 2021
Delayed levodopa-responsive parkinsonism following acute midbrain injury
Tali Friedman-Korn1, Caroline Weill1, Simona Ben-Haim2
1Department of Neurology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
Abstract:
Acute midbrain injury may cause both hyperkinetic movement disorders and parkinsonism. The temporal interval between the insult and the emergence of hyperkinetic disorders can last years. A delayed appearance of parkinsonism, on the other hand, was rarely described. We present three cases of male patients (50-, 58- and 28-year-old) who developed levodopa-responsive parkinsonism 20, 8 and two years, respectively, after acute brain insult involving the midbrain. Insults included subcortical intracerebral hemorrhage dissecting into the midbrain, embolic basilar occlusion and trauma. A fluorodopa scan, performed in two cases, revealed reduced striatal uptake. All individuals improved on low doses of levodopa and developed motor fluctuations shortly after levodopa was introduced. We conclude that delayed, levodopa-responsive parkinsonism following midbrain injury should be recognized in the relevant clinical setup. Possible mechanisms include age-related loss of dopaminergic neurons superimposed on acute injury and secondary neurodegeneration.
Insights
Delayed parkinsonism after acute midbrain injury is rare but should be recognized. Three male patients developed levodopa-responsive parkinsonism years after midbrain insults, showing reduced striatal uptake.
Area of Science:
- Neurology
- Neuroscience
- Movement Disorders
Background:
- Acute midbrain injury can lead to hyperkinetic movement disorders or parkinsonism.
- Delayed onset of parkinsonism after midbrain injury is infrequently reported.
Purpose of the Study:
- To describe cases of delayed, levodopa-responsive parkinsonism following acute midbrain insults.
- To highlight the importance of recognizing this condition in clinical practice.
Main Methods:
- Case series of three male patients with midbrain injury.
- Clinical assessment, including response to levodopa.
- Fluorodopa scans to assess striatal uptake in two patients.
Main Results:
- Patients developed parkinsonism 2, 8, and 20 years post-midbrain insult.
- Insults included hemorrhage, embolism, and trauma.
- All patients showed improvement with levodopa and developed motor fluctuations.
Conclusions:
- Delayed, levodopa-responsive parkinsonism can occur after midbrain injury.
- Potential mechanisms include superimposed age-related dopaminergic loss and secondary neurodegeneration.
- This condition warrants recognition in relevant clinical settings.
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