Abstract
Objective: To outline the importance of neuroimaging in cases of early Parkinson’s disease with subacute onset of progressive unilateral hand tremor.
Background: Parkinsonism can be primary (idiopathic) or secondary in nature. Secondary parkinsonism can be due to metabolic disorders, intoxication, cerebrovascular disorders, head injuries, or infectious etiologies. Intracranial tumor is an established, but rare cause of secondary parkinsonism. We report a patient who presented with early parkinsonism and was subsequently found to have a large anterior cranial fossa meningioma with mass effect on neuroimaging.
Design/Methods: A 65-year-old right handed African American woman with no significant medical history presented with a 3 month history of progressive resting tremor of the right hand. The patient reported no headache or visual disturbances. On examination, the patient manifested mild features of early Parkinson’s disease, including bradykinesia and mild cogwheel rigidity at the elbows. Given the history of subacute onset of symptoms with progressive worsening, an MRI brain was ordered. It revealed a large anterior cranial fossa meningioma occupying both frontal lobes. There was downward compression and mass effect on the head of the caudate bilaterally, though greater on the right side. The patient underwent tumor resection. The cogwheel rigidity improved post-resection, but she continued to have a mild right-handed resting tremor without further progression of disease.
Results: Not applicable
Conclusions: We present an interesting case of large anterior cranial fossa meningioma with mass effect on the caudate presenting with secondary parkinsonism. This represents a mechanical compression of the basal ganglia without direct basal ganglia involvement. To our knowledge, this is the first reported case of residual right-hand resting tremor despite surgical resection, which may indicate chronic damage to the basal ganglia from mass effect. These patients should be challenged with dopamine agonists to monitor their response to the treatment and assess future outcome.
Disclosure: Dr. Khetarpal has nothing to disclose. Dr. Al-Janabi has nothing to disclose. Dr. Memon has nothing to disclose.
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