Akinetic Mutism and Parkinsonism after Multiple Shunt Failure: Case Report and Literature Review

Rebai, Rayhane; Houissa, S.; Mustapha, Musa; Azzouni, H.; Assaggaf, Saggaf Alawi

doi:10.1055/s-0032-1313632

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…Movement disorders associated with cerebrospinal uid shunts are very rare, although ataxia,parkinsonism,dystonia,chorea,ballismus, and torticollis can occur (Table 1). "Altered CSF dynamics" due to the insertion of CSF shunt might be a mechanism related to movement disorders ,Shunt tip blockage or indentation can cause the development of hydrocephalus along with irritation, shearing or ischemia to the striatal projection (7)(8)(9)(10)(11)(12)(13)(14) . As hemichorea related to shunt placement is very rare we could nd only two previous case study on shunt-related hemichorea, which are resolved after shunt repositioning (5) In our case, the mechanism of the movement disorder probably local irritation and likely aetiology, as the symptoms manifested immediately after the procedure along with post operative MRI shows the new formation of micro-infract in the caudate nucleus, putamen, globus pallidus and brain stem.…”

Section: Discussionmentioning

confidence: 99%

A ventriculoperitoneal shunt induced chorea: A case report and review of the literature of movement disorders associated with shunt

Nayak,

Naikwade,

Mahamuni

2024

Preprint

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Background: Hemi-chorea following placement of a ventriculoperitoneal shunt in a patient with hydrocephalus is rare. This complication is often misdiagnosed, which delays treatment. Here we present a rare case of hemichorea following placement of a ventriculoperitoneal shunt and the literature on movement disorders associated with the CSF shunt. Case presentation: A 1.5-year-old male child B/B parents with chief complaints of multiple episodes of emesis and lethargy. Non-contrast CT is suggestive of hydrocephalus. The patient underwent a cerebrospinal fluid diversion procedure; a ventriculoperitoneal shunt was placed through a right occipital approach. After the procedure, he developed brief, abrupt, irregular, unpredictable, non-stereotyped choreo-athetotic movements of the left upper and lower limbs. These movements cause problems with feeding. Post operative-MRI scan of the brain showed the tip of the shunt abutted the medial aspect of the thalamus and caudate nucleus and diffuse foci of micro infracts involving the left caudate and putamen, as well as the right internal capsule and putamen, and the brain stem. Symptoms showed a good response to tablet aspirin. Conclusion: We report that hemichorea is an uncommon complication of ventriculo-peritonieal shunt. placement. Neurosurgeons should know the early warning signs for focal deficits, including unilateral movement disorders, in patients with CSF diversion procedures, and postoperative MRIs also help in diagnosing the cause of movement disorders.

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Section: Discussionmentioning

confidence: 99%

A ventriculoperitoneal shunt induced chorea: A case report and review of the literature of movement disorders associated with shunt

Nayak,

Naikwade,

Mahamuni

2024

Preprint

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“…According to the physiopathology mentioned above, if the presynaptic nigrostriatal dopaminergic pathway is involved, the patient should have a positive response to levodopa. In previous case reports, 28 patients (28/38) were treated with high-dose levodopa with a maximum dose of 1500 mg/d [ 7 , 9 , 10 , 12 – 21 , 23 – 26 , 29 ], and combination treatments such as amantadine and bromocriptine were used in 17 patients [ 8 , 13 – 15 , 18 , 24 – 26 , 29 ]. Twenty-three patients (23/28) who were on levodopa had significant positive effects after 3 days to 6 months of treatment; their clinical symptoms were obviously improved, the dose of levodopa could be reduced slowly after 1 year, and no recurrence was observed after the drug therapy was stopped [ 7 , 9 , 12 – 14 , 16 – 20 , 23 – 27 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Parkinsonism after ventriculoperitoneal shunt for hydrocephalus

et al. 2023

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Background Parkinsonism after ventriculoperitoneal shunt in patients with hydrocephalus is a rare and profound complication that is often misdiagnosed, causing treatment to be delayed. To date, the characteristics of this disease have not been well described and summarized. Here, we report a rare case of parkinsonism after ventriculoperitoneal shunt; symptoms were aggravated by antipsychotic drugs but showed a good response to Madopar. Such cases have rarely been reported previously. Case presentation A 44-year-old man presented with parkinsonism, bilateral pyramidal tract signs, and oculomotor impairment four years after a successful ventriculoperitoneal shunt for idiopathic aqueduct stenosis resulting in obstructive hydrocephalus. Brain magnetic resonance imaging and computed tomography showed fluctuations in the lateral ventricle and the third ventricle without any intervention. The patient’s condition was aggravated by antipsychotic drugs but showed a good response to Madopar. Conclusion This observation suggests that parkinsonism in this patient was caused by reversible dysfunction of the presynaptic nigrostriatal dopaminergic pathway due to fluctuations in the lateral ventricle, representing the first hit to the dopaminergic signalling pathway, and antipsychotic drugs had an antagonistic effect on dopamine D2 receptors, representing the second hit. In addition, we summarize the pathophysiological mechanisms, clinical manifestations, treatments, and prognoses of this complication in 38 patients who met the inclusion criteria in 24 previous studies to increase neurologists’ understanding of the disease.

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“…As previously reported in parkinsonism and/or AM after VPS for hydrocephalus, the majority of patients treated with levodopa achieved significant improvement (1-3, 5-7, 10-22). A few patients received dopamine agonist and/or amantadine, and achieved efficacy (15,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Anticholinergic drugs have also been reported to relieve symptoms (3, 13, 22) (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Case report: Levodopa-responsive parkinsonism with akinetic mutism after ventriculo-peritoneal shunt

Zhang

et al. 2023

Front. Neurol.

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BackgroundParkinsonism and akinetic mutism (AM) following ventriculo-peritoneal shunt (VPS) without underdrainage used to be considered rare, but may be underdiagnosed in daily clinical practice. Although the pathophysiology is still unclear, in several case reports, the parkinsonism and AM after VPS shows responsiveness to dopaminergic treatment.Case presentationWe report a 19-year-old male that presented with severe parkinsonism and AM after VPS. Meanwhile, 18F-FDG-PET showed a cortical and subcortical hypometabolism. Fortunately, levodopa dramatically improved patient's symptoms and brain hypometabolism. This report provides support for the possibility that dopamine deficiency inhibits brain metabolism, and further elucidates the pathogenesis of parkinsonism and AM.ConclusionThis report highlights the presentation of a treatable parkinsonism and points out that Levodopa and/or dopamine agonist should be the first choice if the patients develop parkinson-like symptoms after VPS.

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Akinetic Mutism and Parkinsonism after Multiple Shunt Failure: Case Report and Literature Review

Cited by 8 publications

References 14 publications

A ventriculoperitoneal shunt induced chorea: A case report and review of the literature of movement disorders associated with shunt

A ventriculoperitoneal shunt induced chorea: A case report and review of the literature of movement disorders associated with shunt

Parkinsonism after ventriculoperitoneal shunt for hydrocephalus

Case report: Levodopa-responsive parkinsonism with akinetic mutism after ventriculo-peritoneal shunt

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