Zhang Ying, Li Ping, Zhang Jifeng, Li Chunyang, Sun Peng, Li Fujun, Jiao Zhuomin
Department of Neurology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China.
Department of Radiology and Nuclear Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Front Neurol. 2023 Jun 2;14:1184713. doi: 10.3389/fneur.2023.1184713. eCollection 2023.
Parkinsonism and akinetic mutism (AM) following ventriculo-peritoneal shunt (VPS) without underdrainage used to be considered rare, but may be underdiagnosed in daily clinical practice. Although the pathophysiology is still unclear, in several case reports, the parkinsonism and AM after VPS shows responsiveness to dopaminergic treatment.
We report a 19-year-old male that presented with severe parkinsonism and AM after VPS. Meanwhile, F-FDG-PET showed a cortical and subcortical hypometabolism. Fortunately, levodopa dramatically improved patient's symptoms and brain hypometabolism. This report provides support for the possibility that dopamine deficiency inhibits brain metabolism, and further elucidates the pathogenesis of parkinsonism and AM.
This report highlights the presentation of a treatable parkinsonism and points out that Levodopa and/or dopamine agonist should be the first choice if the patients develop parkinson-like symptoms after VPS.
过去认为，在没有引流不足的情况下，脑室-腹腔分流术（VPS）后出现帕金森综合征和运动不能性缄默症（AM）较为罕见，但在日常临床实践中可能存在漏诊情况。尽管其病理生理学仍不清楚，但在一些病例报告中，VPS后的帕金森综合征和AM对多巴胺能治疗有反应。
我们报告一名19岁男性，在VPS后出现严重的帕金森综合征和AM。同时，氟代脱氧葡萄糖正电子发射断层扫描（F-FDG-PET）显示皮质和皮质下代谢减低。幸运的是，左旋多巴显著改善了患者的症状和脑代谢减低情况。本报告为多巴胺缺乏抑制脑代谢这一可能性提供了支持，并进一步阐明了帕金森综合征和AM的发病机制。
本报告突出了一种可治疗的帕金森综合征的表现，并指出如果患者在VPS后出现帕金森样症状，左旋多巴和/或多巴胺激动剂应作为首选治疗药物。
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