Delayed hemiparkinsonism after closed head injury

Hemiparkinsonismo tardio após traumatismo craniano fechado

A 40-year-old man complained of insidiously-reduced right arm dexterity, which started three years previously. He had had a severe closed head injury 19 years before. At the examination, he presented with rigidity, akinesia, and dystonia uniquely over the right side. According to Crouzon and Justin-Besancon, the criteria for traumatic secondary parkinsonism are severe trauma, brain concussion, and a temporal relationship between the trauma and symptoms¹. In this patient, presynaptic dopaminergic imaging corroborated nigrostriatal denervation induced, presumably, by a previous traumatic hemorrhage. As a result, neuroimaging (Figures 1 and 2) showed specific features that validated the diagnosis of parkinsonism secondary to a traumatic etiology^2,3.

Figure 1
Magnetic resonance imaging, with T2 (A), and susceptibility weighted imaging (B), discloses, in detail, a focal lesion with hemosiderin deposits, over the left cerebral peduncle and substantia nigra.

Figure 2
Scintigraphic imaging with single photon emission computed tomography shows normal 99mTc-TRODAT uptake in the right striatum, and absence of the radionuclide concentration on the left side.

References

• ¹
  Crouzon O, Justin-Besancon L-E. Post-traumatic parkinsonism. Presse Med. 1929;37:1325-7. https://doi.org/10.1016/j.lpm.2017.01.018
  » https://doi.org/10.1016/j.lpm.2017.01.018
• ²
  Loher TJ, Krauss JK. Dystonia associated with pontomesencephalic lesions. Mov Disord. 2009;24(2):157-67. https://doi.org/10.1002/mds.22196
  » https://doi.org/10.1002/mds.22196
• ³
  Krauss JK, Jankovic J. Head injury and posttraumatic movement disorders. Neurosurgery. 2002;50(5):927-39. https://doi.org/10.1097/00006123-200205000-00003
  » https://doi.org/10.1097/00006123-200205000-00003

Publication Dates

• Publication in this collection
  Jan 2018

History

• Received
  18 Nov 2016
• Reviewed
  29 Aug 2017
• Accepted
  05 Sept 2017