Parkinsonism secondary to metastatic lesions within the central nervous system: a case report

Abstract

IntroductionColorectal cancer is one of the most common human diseases worldwide, and metastases are detected in approximately 20% of patients at diagnosis. Brain metastases occur in only 4% of cases, however, and usually present with hemiparesis or other motor or sensory symptoms. There have been only a few reports of parkinsonism secondary to a brain tumor-related mass effect.Case presentationWe present an unusual case of parkinsonism secondary to multiple brain metastases. A 57-year-old Caucasian man had recently been diagnosed with primary carcinoma of the colon and had multiple metastases in the lungs and liver. He subsequently developed bilateral symmetrical parkinsonism, and multiple brain tumors were detected by computed tomography scanning. The condition of our patient deteriorated rapidly, and he became akinetic and dependent for all activities of daily living. He was followed up and treated at home by our palliative care unit team and died two weeks after the onset of his neurologic symptoms.ConclusionAlthough primary and secondary brain tumors are uncommon causes of parkinsonism, their clinical presentation may resemble that of idiopathic Parkinson's disease. An awareness of this rare differential diagnosis is therefore important in ensuring early diagnosis and treatment, thus improving prognosis and quality of life. A rapid progression in neurologic symptoms was observed in our patient, and clinicians should be alert to this atypical presentation of secondary parkinsonism.

Neoplastic Parkinsonism: An illustrative case report

“…Supratentorial lesions involving the caudate-putamen or the striatonigral tract are the most common lesions described in these reports. Metastatic causes have been previously reported with colorectal cancer patients[1] and rarely with non-killer T-cell type of peripheral T-cell lymphoma. [2]…”

“…Not more than 90 cases of tumor related Parkinsonism have been reported in literature. [1] Peripheral T-cell lymphoma unspecified (PTCLUS) is a rare form of non-Hodgkin's lymphoma with less than 5% of patients developing brain metastasis. To the best of our knowledge this is the first report of PTCLUS wherein the clinical manifestations of cerebral metastatic disease evolved over 3 years, in the form of extrapyramidal dysfunction.…”

Tumoral parkinsonism—Parkinsonism secondary to brain tumors, paraneoplastic syndromes, intracranial malformations, or oncological intervention, and the effect of dopaminergic treatment

“…Tumor entities are most often meningioma, followed by glioma (usually astrocytoma), central nervous system (CNS) lymphoma, and craniopharyngioma (Höllerhage, 2019 ). Various types of brain cysts, cavernomas, and brain metastases have also been reported to cause secondary parkinsonism (Chang et al., 2000 ; Hortelano et al., 2010 ; Ishihara et al., 2011 ). Other relevant medical causes in the context of a broader definition of tumoral parkinsonism include paraneoplastic syndromes (PNSs) (Golbe et al., 1989 ; Topcular et al., 2013 ) and iatrogenic oncological parkinsonism (Franchino et al., 2019 ; Markman et al., 1985 ; Skiming et al., 2003 ; Wenning et al., 1999 ).…”

Primary Central Nervous System Lymphoma Presenting as Parkinsonism with Atypical MRI Findings and Elevated 14-3-3 Protein

“…2 Despite the involvement of basal ganglia in CNS lymphomas, only a handful cases have been reported with movement disorders like segmental dystonia, choreoathetosis, and Parkinson's disease. [3][4][5][6][7][8] We presented an unusual case of gradually progressing Parkinsonism with an elevation of CSF 14-3-3 protein and atypical imaging findings found to have PCNSL.…”

“… 2 Despite the involvement of basal ganglia in CNS lymphomas, only a handful cases have been reported with movement disorders like segmental dystonia, choreoathetosis, and Parkinson’s disease. 3 4 5 6 7 8 …”