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March 30, 2021; 96 (13) Resident & Fellow Section

Teaching NeuroImages: Parkinsonism Secondary to a Metastatic Lesion Involving the Substantia Nigra

Kosei Hirata, Takanori Yokota, Yoshiharu Miura
First published November 9, 2020, DOI: https://doi.org/10.1212/WNL.0000000000011162
Kosei Hirata
From the Department of Neurology (K.H., Y.M.), Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital; and Department of Neurology and Neurological Science (K.H., T.Y.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
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Takanori Yokota
From the Department of Neurology (K.H., Y.M.), Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital; and Department of Neurology and Neurological Science (K.H., T.Y.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
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Yoshiharu Miura
From the Department of Neurology (K.H., Y.M.), Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital; and Department of Neurology and Neurological Science (K.H., T.Y.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
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Teaching NeuroImages: Parkinsonism Secondary to a Metastatic Lesion Involving the Substantia Nigra
Kosei Hirata, Takanori Yokota, Yoshiharu Miura
Neurology Mar 2021, 96 (13) e1800-e1801; DOI: 10.1212/WNL.0000000000011162

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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.

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Figure Brain MRI Findings

(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

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No targeted funding reported.

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The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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  • Teaching slides links.lww.com/WNL/B267

  • © 2020 American Academy of Neurology

References

  1. 1.↵
    1. Yasuhara T,
    2. Agari T,
    3. Kambara H, et al
    . Parkinsonism related to brain tumors: a case report and review of the literature. Open Neurosurg J 2009;2:4–7.
    OpenUrlCrossRef
  2. 2.↵
    1. Joutsa J,
    2. Horn A,
    3. Hsu J,
    4. Fox MD
    . Localizing parkinsonism based on focal brain lesions. Brain 2018;141:2445–2456.
    OpenUrl

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  • All Clinical Neurology
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  • Metastatic tumor

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