Dramatic unilateral decrease in uptake via the dopamine transporter: Imaging in a patient with hemiparkinsonism following the lacunar stroke in substantia nigra

@#Vascular parkinsonism (VaP) is typically defined as having predominant lower body involvement, postural instability, less prominent rest tremor and little or no response to treatment with levodopa. In this study, we report a patient with VaP with clear demonstration of a dramatic unilateral decrease of radiotracer uptake in a 18F-FP-CIT-PET study. A 62-year-old right-handed woman was referred to the neurology department due to rest tremor and rigidity in the right hand, which began after undergoing resection surgery for a left acoustic neuroma 7 years prior. Brain MRI, taken at 1 year after surgery showed an ischemic stroke lesion in the left medial pons and the left substantia nigra. 18F-FP-CIT-PET revealed a marked reduction of radiotracer uptake in left striatum compared to that of the right. We treated the patient with 100 mg of levodopa, 200 mg of entacarpone and 25 mg of carbidopa. There was an improvement in bradykinesia and tremor, but the symptoms persisted, and there was no deterioration during 6 months of observation. After acoustic neuroma surgery, ischemic complications are uncommon, and even a small lesion in the nigrostriatal pathway can cause a hemiparkinsonism. If a patient experience sudden onset hemiparkinsonism, they should be carefully examined for lesions in the nigrostriatal pathways. Under these conditions, the 18F-FP-CIT-PET scan can enable visualization of a unilateral decrease and is a useful tool for diagnosis and differentiation from idiopathic Parkinson’s disease

Clinical effect of Danhong injection combined with acupuncture in the treatment of vascular parkinson / 国际中医中药杂志

Objective To study the clinical effect of Danhong injection combined with acupuncture in the treatment of vascular Parkinson syndrome (VP). Methods A total of 98 patients with VP who were treated in the hospital from January 2015 to January 2017 were enrolled in this study. According to the digital random table method, the patients were divided into two groups, the observation group and the control group with each 49 cases. Both groups were given basic treatment, and based on that, the observation group was treated with Danhong injection and acupuncture treatment. Both groups were compared before and after 8 weeks of treatment with the outcome indices of exercise and motor function score, blood rheology index and cerebral hemodynamic indexes, as well as adverse reactions. Results The total effective rate of the observation group was 87.76% (43/49), while the control group was 71.43% (35/49), and the difference was statistically significant(χ 2=4.021,P<0.05).After treatment,the motor function score(27.4 ± 10.5 vs.32.8 ± 8.2,t=2.865), the scores of non-motor function(4.1 ± 2.2 vs.9.8 ± 4.0,t=8.785)of the observation group were lower than those of the control group(P<0.05).After treatment,the plasma viscosity(1.49 ± 0.21 mPa?s vs.1.64 ± 0.28 mPa?s,t=3.000),fibrinogen(3.18 ±0.77 g/L,vs.3.86 ±0.70 g/L,t=4.574),and the RI index(0.49 ±0.12 vs. 0.62 ± 0.16, t=4.550) of the observation group was significantly lower than those of the control group (P<0.05). The Vs(81.97 ± 12.65 cm/s vs.74.39 ± 9.48 cm/s,t=3.357) and Vm(61.54 ± 7.10 cm/s vs.55.87 ± 6.24 cm/s,t=4.199) of observation group was significantly higher than those of the control group(P<0.05). The total incidence of adverse reactions in the observation group was 14.29%, which was no significant difference compared with that of the control group of 16.33%(χ 2=0.079,P>0.05).Conclusions The Danhong injection combined with acupuncture showed better effect on VP patients, and it could improve the clinical symptoms and blood circulation.

Parkinsonismo induzido por trazodona durante o tratamento de hérnia discal lombar: relato de caso / Trazodone induced parkinsonism during lumbar disc herniation treatment: case report

A utilização de medicações psicoativas vem crescendo ao longo dos anos, sendo essencial o conhecimento de seus efeitos colaterais e interações medicamentosas. O desenvolvimento de distúrbios de movimento associados ao uso dessas substâncias é uma situação bastante desconfortável para o paciente, sendo essencial o diagnóstico adequado mediante forte suspeição. Relata-se o caso de um paciente que desenvolveu sintomas de parkinsonismo durante tratamento de hérnia discal lombar na vigência do uso de trazodona. É dada ênfase aos mecanismos de produção desse fenômeno e à sua condução clínica...

The use of psychoactive medications has been growing over years, being essential the knowledge of its side effects and interactions. The development of movement disturbances is a very uncomfortable situation for the patient, requiring a high suspicion for adequate diagnosis. A case of a patient who presented symptoms of Parkinsonism during use of Trazodone in the treatment of lumbar disc herniation is reported. Emphasis is given to the biological mechanisms of this phenomenon and its clinical conduction...

A Case of Valproate-induced Reversible Parkinsonism

Valproate is one of the most popular conventional anti-epileptic drugs. It has many side effects and in rare cases, it may result in the development of parkinsonian syndromes. The parkinsonism with valproate shows insidious onset and reversible symptoms after drug withdrawal. We observed a 69-year-old woman with resting tremor, bradykinesia, cog-wheel rigidity after 2 months of valproate use. She had been suffering from epilepsy for 30 years. Her seizures were well controlled with valproate, but parkinsonian symptoms slowly progressed with doses of 1200 mg/day of valproate. After 4 months, we discontinued the doses of valproate which led to subjective and objective improvement of the parkinsonian features. The mechanism of this side effect is not well established, but GABAergic neurotransmission or mitochondrial respiratory chain may possibly be related.