Cerebral Infratentorial Large B-Cell Lymphoma Presenting as Parkinsonism

Primary central nervous system lymphoma presenting with Parkinsonism as an initial manifestation: A case report and literature review

“…PCNSL presents various clinical symptoms, such as focal neurologic deficit in 70% of patients, behavioral neuropsychiatric changes in 43%, headache, nausea, and vomit associated with elevated intracranial pressure in 33%, and seizures in 14% (3). However, TAP in PCNSL is extremely rare, and only 5 cases, including ours, have been reported so far (Table I) (4)(5)(6)(7). TAP in PCNSL is relatively common in older patients, with a mean age at diagnosis of 74.2 (range, 64-81) years, and no sex preference, with three male and two female patients.…”

Parkinsonism and cerebrospinal fluid disorders

“…Parkinsonism is not common in patients with obstructive hydrocephalus, reported especially when related to non-tumoral aqueductal stenosis [62][63][64]. In hydrocephalus caused by malignant processes, it is difficult to differentiate parkinsonism caused by the neoplasm itself from parkinsonism deriving from secondary hydrocephalus [65,66]. Therefore, parkinsonism is mostly reported by case reports (Table 2).…”

“…Therefore, parkinsonism is mostly reported by case reports (Table 2). Diverse parkinsonian signsincluding bradykinesia, rigidity, rest tremor, gait disturbance, and postural instabilityhave been described, and the subsequent involvement can be asymmetric or even unilateral [62][63][64][65][66][67][68].…”

“…Parkinsonism in obstructive hydrocephalus improved after VPS in all reported cases [62][63][64]66,68], althoughonce againsome of them relapsed even after surgery [62,64,66]. As for the pharmacological treatment before surgery, levodopa was tried only in two subjects [65,67], and one patient showed a significant improvement [67].…”

Movement Disorders and Hematologic Diseases

“…Primary central nervous system lymphomas (PCNSL) comprise a small population of all intracranial malignancies 100 . Movement disorders as a presenting sign of PCNSL are quite rare, but there have been reports of chorea, 101,102 dystonia, 101 including torticollis, 103 and parkinsonism 104–110 at presentation. There have also been reports of paroxysmal kinesigenic dyskinesia and non‐paroxysmal dyskinesia, related to PCNSL tumor involvement of the thalamus 111 and systemic lymphoma involvement of the spinal cord 112 respectively.…”