Hemiparkinsonism Secondary to Giant Aneurysm

Abstract

An 81-year-old woman presented with progressive right levodopa-nonresponsive hemiparkinsonism for 6 months. Brain CT scan and MRI (Figure 1) showed a giant supraclinoid unruptured aneurysm of the left internal carotid artery, leading to severe left basal ganglia displacement and left cerebral peduncle compression. The patient underwent ioflupane SPECT (Figure 2) that showed decreased tracer binding exclusively in the left putamina and left caudate nuclei. The preserved presynaptic dopaminergic function of right basal nuclei ruled out an unmasked latent Parkinson disease.

Hemiparkinsonism caused by a lateral sphenoid wing meningioma, with tractography analysis: illustrative case

“…Besides meningioma, other entities such as various CNS tumors, large arachnoid cysts, giant aneurysms, cavernoma, and chronic subdural hematoma have been reported to potentially cause secondary parkinsonism. 3,4,6,[11][12][13] The mechanisms causing extrapyramidal symptoms can be direct pressure to the basal ganglia nuclei, compression of midbrain structures, or damage to white matter tracts connecting the basal ganglia and cortical/mesencephalic areas. In our literature search, we found only one publication reporting the use of DTI analysis with the aim to visualize the corticospinal tract for surgical planning, rather than to understand the pathophysiology.…”

“…2 One possible and rare cause of hemiparkinsonism is direct mechanical compression of the basal ganglia. [3][4][5][6] Different spaceoccupying lesions causing parkinsonism have been described in the literature: tumors, large arachnoid cysts, giant aneurysms, and chronic subdural hematoma. [3][4][5][6] Here, we present a rare case of a large lateral sphenoid wing meningioma causing hemiparkinsonism.…”

“…[3][4][5][6] Different spaceoccupying lesions causing parkinsonism have been described in the literature: tumors, large arachnoid cysts, giant aneurysms, and chronic subdural hematoma. [3][4][5][6] Here, we present a rare case of a large lateral sphenoid wing meningioma causing hemiparkinsonism. Meningiomas are relatively common intracranial tumors, comprising 36.6% of all primary central nervous system (CNS) tumors with an overall incidence of 8.3 per 100,000 persons in the Western population.…”