Asada Tomohiko, Takayama Yoshihiro, Tokuriki Yasuhiko, Fukuyama Hidenao
Department of Brain Functional Imaging, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Neuroimaging. 2007 Jul;17(3):269-71. doi: 10.1111/j.1552-6569.2007.00113.x.
We report a 70-year-old man who was hospitalized after a left-sided partial seizure progressed to grand mal seizures. Three years before, the patient had presented with the main symptoms of bradykinesia and gait disturbance and was diagnosed with parkinsonism resistant to L-dopa. At the latest admission, extensive diffuse white matter high-intensity areas were present on T2-weighted magnetic resonance imaging images, and stereotactic brain biopsy showed that these lesions were gliomatosis cerebri (GC). This is the first reported case in which extensive lesions in the bilateral white matter have been associated with parkinsonism as the main clinical feature; only one other case has been reported in which GC presented as parkinsonism, and this differed from the current case with respect to localization and symptoms. We speculate that damage to the thalamocortical projections and functional impairment due to demyelination could have caused parkinsonism in our patient, and we discuss the differential diagnosis.
我们报告了一名70岁男性，其左侧部分性癫痫发作进展为全身性强直阵挛发作后住院。三年前，患者出现运动迟缓及步态障碍等主要症状，被诊断为对左旋多巴耐药的帕金森症。在最近一次入院时，T2加权磁共振成像显示广泛的弥漫性白质高强度区域，立体定向脑活检显示这些病变为大脑胶质瘤病（GC）。这是首例报道的以帕金森症为主要临床特征且双侧白质存在广泛病变的病例；仅另有一例报道GC表现为帕金森症，但该病例在定位和症状方面与当前病例不同。我们推测丘脑皮质投射受损及脱髓鞘导致的功能障碍可能是该患者出现帕金森症的原因，并对鉴别诊断进行了讨论。
