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

Abstract

We report on a 56-year-old man who developed a rapidly progressive parkinsonism and apraxia over 2 months due to biopsy confirmed cerebral non-Hodgkin lymphoma primarily involving the SMA and parts of the superior frontal gyrus bilaterally.

Reversible Choreoathetosis in Primary Cerebral Lymphoma: Clinicoradiologic Correlation

“…Movement disorders as an initial presentation of primary cerebral lymphoma are rare [2][3][4]6]. Previous reports included a 66-year-old woman who presented with left arm chorea, followed by hemifacial dystonic spasms and torticollis and dystonia in the contralateral arm [2], and patients who presented with parkinsonism [3,4,6]. However, our patient is unique as she had reversible isolated choreoathethosis and, unlike the previous report [2], the caudate nuclei were not involved.…”

“…Presumed paraneoplastic choreic movements in non-Hodgkin's lymphoma have been highlighted [5]. Movement disorders as an initial presentation of primary cerebral lymphoma are rare [2][3][4]6]. Previous reports included a 66-year-old woman who presented with left arm chorea, followed by hemifacial dystonic spasms and torticollis and dystonia in the contralateral arm [2], and patients who presented with parkinsonism [3,4,6].…”

“…While symptomatology largely depends on the location, movement disorders as the initial presentation are very rare [2][3][4]. We report a patient with PCNSL who presented with acute onset of choreoathethosis which subsequently resolved on treatment.…”

Selective loss of pyramidal neurons in the pre‐supplementary motor cortex in Parkinson's disease

“…When this is coupled with a loss of thalamic drive to the same nonprimary motor regions, slowness and difficulties with movement initiation are bound to ensue. Increasing the excitatory drive to the nonprimary motor regions should and does alleviate the symptoms of PD,3 whereas pathological lesions affecting these nonprimary motor regions leads to rapidly progressive parkinsonism unresponsive to dopaminergic therapies (for review, see Haussermann et al40). There have been few studies selectively activating the pre‐SMA, but our data are consistent with recent repetitive transcranial magnetic stimulation studies which show a worsening of PD symptoms after stimulation of the pre‐SMA41 and a significant improvement after stimulation of the primary motor region 42.…”

Cerebral Infratentorial Large B-Cell Lymphoma Presenting as Parkinsonism

“…Sciarra and Sprofkin (1953) reported that 2.1% of patients with Parkinsonism had cerebral tumors and Tolosa and Vilato (1965) reported a frequency of 1%. Most of tumors which result in Parkinsonism involve the basal ganglia (Pramstaller et al 1999), supplementary motor area (Haussermann et al 2001), corpus callousm (Sánchez-Guerra et al 2001), or frontal lobe (Bucciarelli and Cavaliere 1991;Krauss et al 1995). Lesions in the infratentorial compartment have only been reported sporadically in the literature (Pohle and Krauss 1999).…”