Takeda Shintaro, Nagasaka Shohei, Suzuki Kohei, Futatsuya Koichiro, Yamamoto Junkoh
Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan.
Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan.
Exp Ther Med. 2024 Oct 9;28(6):452. doi: 10.3892/etm.2024.12742. eCollection 2024 Dec.
Parkinsonism can be caused by a variety of factors, such as drugs, vascular disease, toxicity, infection, and autoimmune, neoplastic, metabolic and functional diseases. Parkinsonism is associated with both motor and nonmotor clinical symptoms. Notably, the accurate diagnosis of Parkinson's disease and parkinsonism remains challenging. Meningioma is the most common type of extraparenchymal brain tumor, which typically presents with headaches, focal symptoms and cranial nerve symptoms. Parkinsonism is a rare initial symptom of meningioma. The present report describes an unusual case of a 70-year-old man who presented with tremors, pill-rolling tremors and left-sided rigidity. In addition, the patient exhibited asymmetrical bradykinesia (left > right) and mild postural instability. Magnetic resonance imaging (MRI) revealed a homogeneously enhanced cerebral falx meningioma and dilated tortuous veins. Dopamine transporter single-photon emission computed tomography revealed decreased I-ioflupane uptake in the right striatum. The patient underwent two surgical interventions due to tumor growth and symptom deterioration. Pathological examination revealed transitional meningioma. Postoperatively, the symptoms of the patient improved, and MRI revealed a residual tumor without basal ganglia mechanical compression or venous congestion. It was hypothesized that involuntary movements, including parkinsonism in the present case, were associated with the disruption of the cortico-cerebellar-cortical and the dentato-rubro-olivary pathways (the Guillain-Mollaret triangle) due to tumor mechanical compression and venous congestion. Meningioma, which is a type of extraparenchymal tumor, is more likely to cause mechanical compression and venous congestion than the infiltration of the basal ganglia circuit, leading to symptom improvement after surgical removal. This case highlights the importance of considering meningioma as a rare cause of lateral parkinsonism and its potential for symptom improvement after surgical intervention.
帕金森综合征可由多种因素引起，如药物、血管疾病、中毒、感染以及自身免疫性、肿瘤性、代谢性和功能性疾病。帕金森综合征与运动和非运动临床症状均有关。值得注意的是，帕金森病和帕金森综合征的准确诊断仍然具有挑战性。脑膜瘤是脑实质外最常见的肿瘤类型，通常表现为头痛、局灶性症状和脑神经症状。帕金森综合征是脑膜瘤罕见的首发症状。本报告描述了一例不寻常的病例，一名70岁男性出现震颤、搓丸样震颤和左侧僵硬。此外，患者表现出不对称性运动迟缓（左侧>右侧）和轻度姿势不稳。磁共振成像（MRI）显示大脑镰脑膜瘤均匀强化及迂曲扩张的静脉。多巴胺转运体单光子发射计算机断层扫描显示右侧纹状体I-碘氟烷摄取减少。由于肿瘤生长和症状恶化，患者接受了两次手术干预。病理检查显示为过渡型脑膜瘤。术后，患者症状改善，MRI显示有残留肿瘤，但无基底节机械性压迫或静脉淤血。据推测，包括本例帕金森综合征在内的不自主运动与肿瘤机械性压迫和静脉淤血导致的皮质-小脑-皮质及齿状核-红核-橄榄核通路（Guillain-Mollaret三角）中断有关。脑膜瘤作为一种脑实质外肿瘤，比基底节回路浸润更易引起机械性压迫和静脉淤血，导致手术切除后症状改善。本病例强调了将脑膜瘤视为侧方帕金森综合征罕见病因的重要性及其手术干预后症状改善的可能性。
