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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.
AuthorsMin Ho Chun, Chang Gu Kang, Eun Jung Kong, Min Cheol Chang
JournalJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 24 Issue 3 Pg. e75-8 (Mar 2015) ISSN: 1532-8511 [Electronic] United States
PMID25543190 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Drug Combinations
  • Radiopharmaceuticals
  • Tropanes
  • carbidopa, levodopa drug combination
  • 2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane
  • Levodopa
  • Carbidopa
Topics
  • Activities of Daily Living
  • Carbidopa (therapeutic use)
  • Caudate Nucleus (diagnostic imaging, physiopathology)
  • Cerebral Ventricles (blood supply)
  • Drainage (adverse effects)
  • Drug Combinations
  • Female
  • Humans
  • Intracranial Hemorrhages (diagnosis, surgery)
  • Levodopa (therapeutic use)
  • Magnetic Resonance Imaging
  • Middle Aged
  • Parkinson Disease, Secondary (diagnosis, drug therapy, etiology, physiopathology)
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • Putamen (diagnostic imaging, physiopathology)
  • Radiopharmaceuticals
  • Recovery of Function
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tropanes
  • Ventriculoperitoneal Shunt (adverse effects)

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