A 74-year-old man with a 9-month history of treatment for metastatic small cell lung carcinoma presented with 3 months of gradual-onset small steps and stooped posture. His medical history was unremarkable except for pneumothorax in his 30s. Neurologic examination revealed bradykinesia, rigidity in the right extremities, stooped posture, and hyperreflexia in all extremities. Brain MRI showed a ring-enhanced lesion in the midbrain involving the left substantia nigra (figure), which was not evident on MRI 4 months earlier. Although he underwent whole-brain irradiation with a marked decrease in the lesion size, his parkinsonism did not remit. He was unresponsive to levodopa up to 300 mg/d. His parkinsonism did not worsen, and he died 4 months after diagnosis.
(A) Axial T2-weighted and (B) T1-weighted images with gadolinium contrast show ring enhanced mesencephalic mass involving left substantia nigra.
Although brain tumors at various locations are associated with parkinsonism, metastatic tumors contacting the substantia nigra comprise a rare but important cause of secondary parkinsonism.1,2
Study Funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures.
Teaching slides links.lww.com/WNL/B267
- © 2020 American Academy of Neurology
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hemiplegic Migraine Associated With PRRT2 Variations A Clinical and Genetic Study
Dr. Robert Shapiro and Dr. Amynah Pradhan