Parkinsonism as an unusual presenting symptom of pineal gland teratoma

Dolendo, Mae; Lin, Tan Poh; Tat, Ong Hian; Chong, Quah Thuan; Timothy, Lee Kam Yiu

doi:10.1016/s0887-8994(02)00620-3

Cited by 19 publications

(24 citation statements)

References 11 publications

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“…Due to the pineal gland’s anatomic location, most patients present with symptoms of increased intracranial pressure, such as, but not limited to: headache, vomiting, ophthalmoplegia, ataxia, lethargy, memory disturbances, seizures, and increased head circumference in infants [1, 13, 18, 20, 21]. Classically, pineal lesions present with noncommunicating hydrocephalus secondary to obstruction of the sylvian aqueduct and Parinaud’s syndrome (paralysis of upgaze, convergence-retraction nystagmus, and light-near dissociation) due to compression of the midbrain tectum [18,21,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Dolendo et al [1] and Vhora et al [5] described evidence of secondary parkinsonism attributed to a pineal gland teratoma and a pineal cavernous angioma, respectively. The etiology of secondary parkinsonism in these lesions remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of secondary parkinsonism in these lesions remains unclear. Compression of posterior thalamus and upper midbrain with congestion of the deep venous system may cause a vascular disturbance in the nigro-striatal-pallidal system [1, 5]. Dolendo et al [1] described a case of secondary parkinsonism in a 14-year-old Chinese boy with an immature pineal gland terato- ma extending to the thalamus; however, he also had hydrocephalus and Parinaud’s syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary parkinsonism is a rare clinical manifestation of intracranial neoplasms occurring in children [1]. Brain tumors causing secondary parkinsonism have previously been reported in the literature [2,3,4,5], but most reports are of supratentorial tumors with compression or infiltration of the basal ganglia or compression of the brainstem [6, 7].…”

Section: Introductionmentioning

confidence: 99%

“…However, there have been reports of posterior fossa cysts or tumors and chronic subdural hematomas associated with secondary parkinsonism [5,8,9,10]. Apart from intracranial lesions, secondary parkinsonism has been reported in association with ventriculoperitoneal shunt failure, hypoxic-ischemic encephalopathy, viral encephalitis, haloperidol treatment, and toxicity to cytosine arabinoside, cyclophosphamide, amphotericin B, and methotrexate [1, 11]. We present a case of a pineal cyst, manifesting as a new-onset progressive, unilateral right-hand resting tremor in an 18-year-old female.…”

Section: Introductionmentioning

confidence: 99%

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Resting Tremor Secondary to a Pineal Cyst: Case Report and Review of the Literature

Morgan¹,

Scumpia

Webster

et al. 2008

Pediatr Neurosurg

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Background: Patients with pineal lesions typically present with the classical signs of increased intracranial pressure (headache, nausea, vomiting) and/or Parinaud’s syndrome. Rare symptomatology of secondary parkinsonism attributed to pineal lesions has been previously reported in the literature. We describe an unusual case of a pineal cyst in a patient with the presenting sign of a resting tremor. Case Description: We report an 18-year-old Caucasian female who presented with a 1-month history of a new-onset progressive, unilateral low-frequency right-hand resting tremor with associated headache, nausea, vomiting, and excessive diarrhea. Magnetic resonance imaging demonstrated an atypical appearance with enhancement of a mildly prominent pineal gland, possibly representing a pineal cyst. The patient did not exhibit radiographic signs of hydrocephalus. Based upon the radiographic appearance, one could not exclude with absolute certainty the presence of a malignancy. The patient ultimately underwent a bilateral suboccipital craniotomy with gross total resection of the lesion. Postoperatively, the patient exhibited immediate resolution of her preoperative resting tremor and continues to be symptom free at 1 year. Conclusions: A new-onset, resting tremor and/or other secondary parkinsonism symptoms should raise clinical suspicions of pineal lesions. Treatment can be guided based on tissue type and the presence or absence of hydrocephalus. We observed that complete surgical resection of the lesion provided the best treatment option for the total resolution of symptoms attributed to the disturbance of the microvasculature surrounding the nigro-striatal-pallidal system.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Resting Tremor Secondary to a Pineal Cyst: Case Report and Review of the Literature

Morgan¹,

Scumpia

Webster

et al. 2008

Pediatr Neurosurg

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Tumoral parkinsonism—Parkinsonism secondary to brain tumors, paraneoplastic syndromes, intracranial malformations, or oncological intervention, and the effect of dopaminergic treatment

et al. 2023

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IntroductionSecondary tumoral parkinsonism is a rare phenomenon that develops as a direct or indirect result of brain neoplasms or related conditions.ObjectivesThe first objective was to explore to what extent brain neoplasms, cavernomas, cysts, paraneoplastic syndromes (PNSs), and oncological treatment methods cause parkinsonism. The second objective was to investigate the effect of dopaminergic therapy on the symptomatology in patients with tumoral parkinsonism.MethodsA systematic literature review was conducted in the databases PubMed and Embase. Search terms like “secondary parkinsonism,” “astrocytoma,” and “cranial irradiation” were used. Articles fulfilling inclusion criteria were included in the review.ResultsOut of 316 identified articles from the defined database search strategies, 56 were included in the detailed review. The studies, which were mostly case reports, provided research concerning tumoral parkinsonism and related conditions. It was found that various types of primary brain tumors, such as astrocytoma and meningioma, and more seldom brain metastases, can cause tumoral parkinsonism. Parkinsonism secondary to PNSs, cavernomas, cysts, as well as oncological treatments was reported. Twenty‐five of the 56 included studies had tried initiating dopaminergic therapy, and of these 44% reported no, 48% low to moderate, and 8% excellent effect on motor symptomatology.ConclusionBrain neoplasms, PNSs, certain intracranial malformations, and oncological treatments can cause parkinsonism. Dopaminergic therapy has relatively benign side effects and may relieve motor and nonmotor symptomatology in patients with tumoral parkinsonism. Dopaminergic therapy, particularly levodopa, should therefore be considered in patients with tumoral parkinsonism.

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