A progressive parkinsonian syndrome developing after chemotherapy and radiotherapy for non‐hodgkin's lymphoma

Abstract

COMMUNICATIONS 73thalamo-cortical loops have shown a similar neuropsychological profile. Verbal memory deficits have been found in both right hemi-Parkinson's disease patients (6) and in a patient with striatonigral degeneration affecting primarily the left putamen (13). Slowed word-list generation is also a recognized phenomenon in Parkinson's disease (14) and language deficits have been found in patients with infarcts primarily affecting the putamen (15). The putamen may thus be a critical structure for the production not only of motor-based programs such as writing, but also of cognitive functions such as word retrieval and verbal learning. ReferencesMartinez-Vila E, Artieda J, Obeso J, A. Micrographia secondary to lenticular haematoma. J Neurol Neurosurg Psychiatry 1988;Sl: 1353-1356. LeWitt PA. Micrographia as a focal sign of neurological disease. J Neurol Neurosurg Psychiatry 1983;46:1152-1157. Yoshida T, Yamadori A, Mori E. [A case of micrographia with the right hand due to left putaminal infarction]. Rinsho Shinkeigaku 1989;29:1149-1151. Feldman JM, Feldman MD. Sequelae of attempted suicide by cyanide ingestion: a case report. Int J Psychiatry Med 1990;20:173-179. Damasio AR, Damasio H, Rizzo M, Varney N, Gersh F. Aphasia with nonhemorrhagic lesions in the basal ganglia and internal capsule. Arch Neurol 1982;39: 15-20. . Starkstein S, Leiguarda R, Gershanik 0, Berthier M. Neuropsychological disturbances in hemiparkinson's disease. Neurology 1987 ;37: 1762-1 764. 7. Speedie LJ, Wertman E, Ta'ir J, Heilman KM. Disruption of automatic speech following a right basal ganglia lesion. Neurology 1993 ;43 : 1768-1774. 8. Nyberg P, Nordberg A, Webster P, Winblad B. Dopaminergic deficiency is more pronounced in putamen than in nucleus caudatus in Parkinson's disease. Neurochemical Pa-9. Oberg RGE, Divac I. "Cognitive" functions of the neostriatum. In: Divac I, Oberg RGE, eds. The neostriatum. Oxford, England: Pergamon, 1979:291-313. 10. Lees AJ, Smith E. Cognitive deficits in the early stages of Parkinson's disease. Brain 1983;106257-270. 11. Marsden CD. What do the basal ganglia tell premotor cortical areas? In: Motor areas of the cerebral cortex. Ciba Foundation Symposium 132. Chichester, England: Wiley,

Chemotherapy‐induced parkinsonism responsive to levodopa: An underrecognized entity

“…There is precedent for such a delay in onset of parkinsonism after chemotherapy. Howell reported a patient with delayed‐onset parkinsonism occurring 4–5 months after a course of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) 13. A causal relationship between the chemotherapy and the parkinsonism was not proven, because the parkinsonism did not remit and, in fact, progressed despite discontinuation of chemotherapy.…”

Primary central nervous system lymphoma in the SMA presenting as rapidly progressive parkinsonism

“…Of the five cases we found in our medline search,5–9 all but one showed bilateral basal ganglia involvement (Table 2). Lymphoma may also produce paraneoplastic movement disorders,23, 24 and a rapidly progressive parkinsonian syndrome has been reported after chemo‐ and prophylactic cranial radiation therapy for extracerebral non‐Hodgkin lymphoma 25…”

Movement disorder emergencies

“…These patients differ in that MRI imaging was normal and their symptoms responded to levodopa. Paclitaxel [13], cystosine arabinoside [83], cyclophosphamide and etoposide [37], vincristine and adriamycin [12], and CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone, [57]) are reported triggers. The response to levodopa and tendency to recover spontaneously suggests a reversible presynaptic inhibition of the nigrostriatal pathway.…”