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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(12): 816
DOI: 10.1590/0004-282X20200103
Images in Neurology

Acute parkinsonism and bilateral basal ganglia lesions

Parkinsonismo agudo e lesão bilateral nos núcleos da base
Rodrigo Alencar e SILVA 
1   Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Unidade de Distúrbios do Movimento, Natal RN, Brazil.
,
Thadeu Alexandre Paulino DESOUSA 
2   Hospital Monsenhor Walfredo Gurgel, Natal RN, Brazil.
,
Clécio GODEIRO-JUNIOR 
1   Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Unidade de Distúrbios do Movimento, Natal RN, Brazil.
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A 58-year-old man with arterial hypertension and poorly controlled type 2 diabetes using glyburide/metformin presented a history of sudden slurred speech and gait disturbance eight days before clinical evaluation. Neurological examination disclosed dysarthria, postural instability and bradykinesia. Laboratory investigations demonstrated low glucose (24 mg/dL), elevated urea nitrogen (168 mg/dL) and creatinine (8 mg/dL) levels. Cranial computerized tomography revealed lentiform “fork sign” ([Figures 1A and 1C]).

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Figure 1 Axial and coronal cranial computerized tomography (A/C) - decreased density in bilateral lentiform nuclei surrounded by a more hypodense rim delineating them - fork-like structure. Cranial computerized tomography (B/D) - regression of lentiform nucleus lesions after three months.

Acute bilateral basal ganglia lesions syndrome is a rare complication of uremia, occurring typically in diabetic patients and characterized by acute parkinsonism and/or involuntary movements[1]. The pathogenesis is unclear and potential causes include metabolic acidosis[1],[2],[3], uremic toxins[1],[3], hemodynamic changes (hypotension/heart failure)[3] and diabetes[1]. In the case reported, hypoglycemia may be implicated as a triggering factor. The patient’s symptoms improved after hemodialysis.

Author's contribution:

All authors contributed equally to the intellectual development, organization and writing of the manuscript and the critical review of the content.




Publication History

Received: 13 June 2020

Accepted: 16 June 2020

Article published online:
07 June 2023

© 2020. 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

  • 1 Juryńczyk M, Rożniecki J, Zaleski K, Selmaj K. Hypoglicemia as a trigger for the syndrome of acute bilateral basal ganglia lesion in uremia. J Neurol Sci. 2010 Oct; 297(1-2):74-5. https://doi.org/10.1016/j.jns.2010.07.016
  • 2 Fabiani G, Teive HA, Munhoz RP. Lentiform fork sign and fluctuating, reversible parkinsonism in a patient with uremic encephalopathy. Mov Disord 2013 Jul; 28(8):1053. https://doi.org/10.1002/mds.25503
  • 3 Moreira RF, Barsottini OG, Pedroso JL. Lentiform “fork sign” and parkinsonism after acute myocardial infarction and cardiac failure. Mov Disord Clin Pract 2017 Feb; 4(4):646. https://doi.org/10.1002/mdc3.12482