Symptomatic hemiparkinsonism due to extensive middle and posterior fossa arachnoid cyst: case report

Wimmer, Bernadette; Mangesius, Stephanie; Seppi, Klaus; Iglseder, Sarah; Pauli, Franziska Di; Ortler, Martin; Gizewski, Elke R.; Poewe, Werner; Wenning, Gregor K.

doi:10.1186/s12883-020-01670-y

Cited by 4 publications

(11 citation statements)

References 11 publications

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“…Tremor caused by AC is rarely described. [4][5][6][7][8] AC usually represent incidental findings of fluid collections in the central nervous system without clinical relevance, for which a conservative treatment approach is generally recommended. 1 In contrast, invasive treatment strategies can be considered for symptomatic AC.…”

Section: Discussionmentioning

confidence: 99%

Successful Surgical Treatment of an Intracranial Arachnoid Cyst Inducing Holmes’ Tremor

Aubignat

Tir

Vandici

et al. 2023

Movement Disord Clin Pract

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Arachnoid cyst (AC) is a fluid-filled malformation of the arachnoid tissue. 1 Congenital, genetic, and traumatic factors have been suggested as the underlying mechanisms. Prevalence is estimated at 2.6% in children and 1.4% in adults. Symptoms such as headache, epilepsy, cognitive impairment, and dizziness are frequently reported in AC patients. However, AC are frequently discovered incidentally in asymptomatic patients undergoing radiological investigation for various other neurological symptoms. The large majority of AC remain constant in size and a conservative management has been proposed for most of the patients. Although there has been considerable controversy regarding the indications for the surgical treatment of asymptomatic AC, the literature seems to show some consensus that patients with symptomatic AC causing seizures, hydrocephalus, increased intracranial pressure, neurological impairment and those complicated by intracystic or subdural hemorrhage should be treated. 2 Before considering surgery for intractable symptoms attributed to AC, their relationship should be explored in detail and objective criterion should be used. The aim of this case report is to illustrate an unusual cause of symptomatic AC inducing Holmes' tremor (HT) successfully treated with surgery. HT is a low-frequency tremor characterized by a combination of rest, posture, and kinetic components. 3

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Section: Discussionmentioning

confidence: 99%

Successful Surgical Treatment of an Intracranial Arachnoid Cyst Inducing Holmes’ Tremor

Aubignat

Tir

Vandici

et al. 2023

Movement Disord Clin Pract

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“…wrote about a patient who was treated with levodopa and pramipexole for hemiparkinsonism associated with an arachnoid cyst. Although the treatment was effective at first, symptoms worsened over time as the underlying cysts progressed, thus leading to low treatment effect (Wimmer et al, 2020). De Sèze et al described a case initially mistaken for idiopathic PD that was managed with 10 mg per day of selegiline and after half a year 300 mg of levodopa per day.…”

Section: Low To Moderate Effectmentioning

confidence: 99%

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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“…Besides meningioma, other entities such as various CNS tumors, large arachnoid cysts, giant aneurysms, cavernoma, and chronic subdural hematoma have been reported to potentially cause secondary parkinsonism. 3,4,6,[11][12][13] The mechanisms causing extrapyramidal symptoms can be direct pressure to the basal ganglia nuclei, compression of midbrain structures, or damage to white matter tracts connecting the basal ganglia and cortical/mesencephalic areas. In our literature search, we found only one publication reporting the use of DTI analysis with the aim to visualize the corticospinal tract for surgical planning, rather than to understand the pathophysiology.…”

Section: Observationsmentioning

confidence: 99%

“…2 One possible and rare cause of hemiparkinsonism is direct mechanical compression of the basal ganglia. [3][4][5][6] Different spaceoccupying lesions causing parkinsonism have been described in the literature: tumors, large arachnoid cysts, giant aneurysms, and chronic subdural hematoma. [3][4][5][6] Here, we present a rare case of a large lateral sphenoid wing meningioma causing hemiparkinsonism.…”

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confidence: 99%

“…[3][4][5][6] Different spaceoccupying lesions causing parkinsonism have been described in the literature: tumors, large arachnoid cysts, giant aneurysms, and chronic subdural hematoma. [3][4][5][6] Here, we present a rare case of a large lateral sphenoid wing meningioma causing hemiparkinsonism. Meningiomas are relatively common intracranial tumors, comprising 36.6% of all primary central nervous system (CNS) tumors with an overall incidence of 8.3 per 100,000 persons in the Western population.…”

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confidence: 99%

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Hemiparkinsonism caused by a lateral sphenoid wing meningioma, with tractography analysis: illustrative case

Saemann¹,

Busch²,

Taub³

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND The etiologies of parkinsonism are diverse. A possible and rare cause of hemiparkinsonism is mechanical compression of the basal ganglia and its connecting white matter tracts. The authors present a case of hemiparkinsonism caused by a lateral sphenoid wing meningioma, discuss the underlying pathophysiology based on tractography, and systematically review the existing literature. OBSERVATIONS A 59-year-old female was referred for a left-sided tremor of the hand, accompanied by a cogwheel rigidity of the left arm. Symptomatology appeared 1 year earlier and worsened in the previous 6 months, finally also showing involvement of the left leg. Magnetic resonance imaging (MRI) showed a space-occupying suspected meningioma originating from the right lateral sphenoid wing and compressing the ipsilateral striatum. Tractography studies contributed to elucidate the underlying pathophysiology. Resection of the meningioma could be performed without complications. At the 4-month follow-up, the patient’s hemiparkinsonism had completely recovered. LESSONS An intracranial space-occupying lesion may be a rare cause of hemiparkinsonism. In new-onset parkinsonism, especially if a secondary form is suspected, brain MRI should be performed promptly to avoid misdiagnosis and treatment. Tractography studies help understand the underlying pathophysiology. After surgical decompression of the affected structures, symptoms can recover completely.

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Symptomatic hemiparkinsonism due to extensive middle and posterior fossa arachnoid cyst: case report

Cited by 4 publications

References 11 publications

Successful Surgical Treatment of an Intracranial Arachnoid Cyst Inducing Holmes’ Tremor

Successful Surgical Treatment of an Intracranial Arachnoid Cyst Inducing Holmes’ Tremor

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

Hemiparkinsonism caused by a lateral sphenoid wing meningioma, with tractography analysis: illustrative case

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