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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(01): 60-61
DOI: 10.1590/0004-282X20170169
IMAGES IN NEUROLOGY

Delayed hemiparkinsonism after closed head injury

Hemiparkinsonismo tardio após traumatismo craniano fechado
Monalisa da Silveira Dias
1   Hospital de Base do Distrito Federal, Unidade de Neurologia, Centro de Distúrbios do Movimento e Doença de Parkinson, Brasília DF, Brasil;
,
Pedro Renato Brandão
1   Hospital de Base do Distrito Federal, Unidade de Neurologia, Centro de Distúrbios do Movimento e Doença de Parkinson, Brasília DF, Brasil;
2   Congresso Nacional, Câmara dos Deputados, Departamento Médico, Brasília DF, Brasil;
,
Talyta Grippe
1   Hospital de Base do Distrito Federal, Unidade de Neurologia, Centro de Distúrbios do Movimento e Doença de Parkinson, Brasília DF, Brasil;
3   Universidade de Brasília, Faculdade de Medicina, Programa de Pós Graduação, Brasília DF, Brasil;
,
Cassio Jovem
4   Clínica Villa Rica, Brasília DF, Brasil;
5   Hospital de Base do Distrito Federal, Departamento de Radiologia, Brasília DF, Brasil;
,
Marcelo Gomes
6   Núcleos Medicina Nuclear, Brasília DF, Brasil.
,
Flávio Faria Pereira
1   Hospital de Base do Distrito Federal, Unidade de Neurologia, Centro de Distúrbios do Movimento e Doença de Parkinson, Brasília DF, Brasil;
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A 40-year-old man complained of insidiously-reduced right arm dexterity, which started three years previously. He had had a severe closed head injury 19 years before. At the examination, he presented with rigidity, akinesia, and dystonia uniquely over the right side. According to Crouzon and Justin-Besancon, the criteria for traumatic secondary parkinsonism are severe trauma, brain concussion, and a temporal relationship between the trauma and symptoms[1]. In this patient, presynaptic dopaminergic imaging corroborated nigrostriatal denervation induced, presumably, by a previous traumatic hemorrhage. As a result, neuroimaging ([Figures 1] and [2]) showed specific features that validated the diagnosis of parkinsonism secondary to a traumatic etiology[2],[3].

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Figure 1 Magnetic resonance imaging, with T2 (A), and susceptibility weighted imaging (B), discloses, in detail, a focal lesion with hemosiderin deposits, over the left cerebral peduncle and substantia nigra.
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Figure 2 Scintigraphic imaging with single photon emission computed tomography shows normal 99mTc-TRODAT uptake in the right striatum, and absence of the radionuclide concentration on the left side.


Publikationsverlauf

Eingereicht: 18. November 2016

Angenommen: 05. September 2017

Artikel online veröffentlicht:
30. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

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  • 2 Loher TJ, Krauss JK. Dystonia associated with pontomesencephalic lesions. Mov Disord. 2009;24(2):157-67. https://doi.org/10.1002/mds.22196
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