PDF(Pubmed)
Abstract：
Parkinsonism is a rare manifestation of brain tumors that has most commonly been reported in association with gliomas and meningiomas. In this paper, we describe a unique case of secondary Parkinsonism that was precipitated by a craniopharyngioma. A 42-year-old female presented with resting tremors, rigidity, and bradykinesia. Her past medical history was significant for a craniopharyngioma resection four months prior. The postoperative course was complicated by severe delirium, panhypopituitarism, and diabetes insipidus. Notably, she was taking haloperidol and aripiprazole daily for four months to manage her delirium and psychotic episodes. Her preoperative brain MRI showed a compressive effect of the craniopharyngioma on the midbrain and nigrostriatum. Drug-induced Parkinsonism was initially suspected given extended treatment with antipsychotics. Haloperidol and aripiprazole were stopped, and benztropine was started with no improvement. Consequently, the patient was treated with carbidopa/levodopa with symptomatic improvement. A dopamine transporter (DaT) scan was done after starting carbidopa/levodopa and showed asymmetric decreased uptake in dopamine transporter in the striatum. Only one other case of Parkinsonism following craniopharyngioma resection was found in the literature review. Unlike our example, the symptoms resolved following surgical intervention and did not require a long-term treatment with carbidopa/levodopa. The purpose of our case report is to highlight brain tumors as a potential cause of secondary Parkinsonism in younger patients for an early surgical intervention can be curative.
摘要：
帕金森病是脑肿瘤的一种罕见表现，最常见的是与神经胶质瘤和脑膜瘤有关。在本文中,我们描述了一例由颅咽管瘤诱发的继发性帕金森病的独特病例.一名42岁的女性出现休息性震颤，刚性,和运动迟缓.她的既往病史对于四个月前的颅咽管瘤切除术具有重要意义。术后病程并发严重谵妄，全垂体功能减退,和尿崩症.值得注意的是,她每天服用氟哌啶醇和阿立哌唑治疗谵妄和精神病发作4个月.她的术前脑部MRI显示颅咽管瘤对中脑和黑质纹状体有压迫作用。最初怀疑药物诱发的帕金森病患者接受了抗精神病药物的延长治疗。停止氟哌啶醇和阿立哌唑，苯并托品开始没有改善。因此,患者接受卡比多巴/左旋多巴治疗,症状有所改善.开始卡比多巴/左旋多巴后进行多巴胺转运蛋白（DaT）扫描，并显示纹状体中多巴胺转运蛋白的不对称摄取降低。在文献综述中，仅发现一例颅咽管瘤切除术后的帕金森病。不像我们的例子,手术干预后症状缓解,不需要卡比多巴/左旋多巴长期治疗.我们病例报告的目的是强调脑肿瘤是年轻患者继发性帕金森病的潜在原因，因为早期手术干预可以治愈。
