Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Institute Of Sleep And Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100053, China.
BMC Neurol. 2023 Jan 24;23(1):38. doi: 10.1186/s12883-023-03064-2.
Parkinsonism after ventriculoperitoneal shunt in patients with hydrocephalus is a rare and profound complication that is often misdiagnosed, causing treatment to be delayed. To date, the characteristics of this disease have not been well described and summarized. Here, we report a rare case of parkinsonism after ventriculoperitoneal shunt; symptoms were aggravated by antipsychotic drugs but showed a good response to Madopar. Such cases have rarely been reported previously.
A 44-year-old man presented with parkinsonism, bilateral pyramidal tract signs, and oculomotor impairment four years after a successful ventriculoperitoneal shunt for idiopathic aqueduct stenosis resulting in obstructive hydrocephalus. Brain magnetic resonance imaging and computed tomography showed fluctuations in the lateral ventricle and the third ventricle without any intervention. The patient's condition was aggravated by antipsychotic drugs but showed a good response to Madopar.
This observation suggests that parkinsonism in this patient was caused by reversible dysfunction of the presynaptic nigrostriatal dopaminergic pathway due to fluctuations in the lateral ventricle, representing the first hit to the dopaminergic signalling pathway, and antipsychotic drugs had an antagonistic effect on dopamine D2 receptors, representing the second hit. In addition, we summarize the pathophysiological mechanisms, clinical manifestations, treatments, and prognoses of this complication in 38 patients who met the inclusion criteria in 24 previous studies to increase neurologists' understanding of the disease.
脑积水患者行脑室-腹腔分流术后发生帕金森病是一种罕见且严重的并发症，常被误诊，导致治疗延误。迄今为止，该疾病的特征尚未得到很好的描述和总结。在此，我们报告一例脑室-腹腔分流术后罕见的帕金森病病例；抗精神病药物可使症状加重，但对美多芭反应良好。此前此类病例鲜有报道。
一名 44 岁男性，因特发性导水管狭窄导致梗阻性脑积水行脑室-腹腔分流术成功四年后出现帕金森病、双侧锥体束征和动眼神经功能障碍。脑磁共振成像和计算机断层扫描显示侧脑室和第三脑室波动，无任何干预措施。抗精神病药物可使患者病情加重，但对美多芭反应良好。
该观察结果提示，该患者的帕金森病是由于侧脑室波动导致的黑质纹状体多巴胺能通路的突触前功能障碍引起，代表多巴胺能信号通路的首次打击，而抗精神病药物对多巴胺 D2 受体具有拮抗作用，代表第二次打击。此外，我们总结了 24 项先前研究中符合纳入标准的 38 例患者的该并发症的病理生理学机制、临床表现、治疗和预后，以增加神经科医生对该疾病的认识。
