Parkinsonism is a common complication of neuroleptic drug use; however, the pathophysiology of the persistence of parkinsonian symptoms after withdrawal of neuroleptic drugs is poorly understood. Twenty patients with neuroleptic induced parkinsonism were studied by high field MRI. Persistence of symptoms was associated with different findings depending on the age of the patients-namely, putaminal hypointensity in young patients and striatal hyperintensities in old patients. High field MRI may be useful in identifying patients at higher risk for neuroleptic induced parkinsonism.blockade,9 and acceleration of idiopathic Parkinson's disease'0 have all been postulated. Functional age related changes in dopamine receptors and striatal concentrations of dopamine may play an important part. An MRI study has shown a high prevalence of focal hyperintensities in the caudate nucleus of aging patients with neuroleptic induced parkinsonism with respect to age matched controls." We therefore studied MRI abnormalities in young and old patients with neuroleptic induced parkinsonism in relation to their clinical course after neuroleptic withdrawal.