Parkinsonismo associado a tumor cerebral relato de caso

Barbosa, Egberto R.; Teixeira, Manoel J.; Chaves, Claudia J.; Scaff, Milberto

doi:10.1590/S0004-282X1991000300019

Resumos

Descreve-se o caso de paciente com síndrome parkinsoniana à direita, associada a disfunções cognitivas e síndrome de hipertensão intracraniana. A tomografia de crânio e o estudo angiográfico de vasos intracranianos demonstraram a presença de volumoso processo expansivo fronto-temporal esquerdo. A eletromiografia revelou tremor de repouso com frequência de 4 a 6 ciclos por segundo. A paciente foi submetida a ressecção cirúrgica da massa tumoral, cujo exame histológico revelou tratar-se de meningioma. A evolução pós-operatória foi excelente e após dois meses todas as anormalidades neurológicas haviam desaparecido. Um ano após a remoção do tumor a paciente permanecia assintomática sem uso de qualquer medicação. São discutidos aspectos fisiopatológicos do parkinsonismo por processo expansivo e as particularidades do presente caso são analisadas em confronto a dados da literatura.

We are presenting an uncommon case of cerebral tumor whose major manifestation was parkinsonism. The patient was a 50-year-old woman presented with a 5-month history of tremor of the right hand, particularly at rest, and headache. On neurological examination of March, 1987 there were: slight right-sided hemiparesis with symmetrical hiperreflexia; discrete bradykinesia in combination with cogwheel rigidity also on the right-side; resting tremor of the right hand; and bilateral papilledema. The neuropsycho-logycal examination disclosed: nominative aphasia, impaired recent memory and right-left disorientation. The computed tomography showed a large, left frontotemporal tumor. Angiograms of the left internal and external carotid arteries revealed a tumor blush in the left frontotemporal region supplied by a enlarged middle meningeal artery. An electromyogram revealed a 4-6 HZ tremor on right hand. A course of treatment with dexametasone 16mg/day and levodopa plus benzerazine (500mg/day) was unsuccessful. A left fronto-temporo-parietal craniotomy was performed and an attached sphenoid wing tumor was mtacroseopically completely removed. Microscopy indicated that the tumor was a meningioma. Postoperativelly, the patient made an uneventful recovery. After two weeks, her right-sided palsy and parkinsonism had disappeared, and neuropsyehologyeal deficits improved. Two months later there was no abnormalities on neurological and neuropsyehologycal examination. It was concluded that the parkinsonism was caused by mechanical pressure on the basal ganglia.

CONTENTS CONTEÚDO

Egberto R. BarbosaI; Manoel J. TeixeiraI; Claudia J. ChavesII; Milberto ScaffIII

IMédico Assistente - Trabalho do Grupo de Estudos de Afecções Extrapiramidais da Divisão de Clínica Neurológica do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

IIMédica Preceptora - Trabalho do Grupo de Estudos de Afecções Extrapiramidais da Divisão de Clínica Neurológica do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

IIIProfessor Titular - Trabalho do Grupo de Estudos de Afecções Extrapiramidais da Divisão de Clínica Neurológica do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

RESUMO

Descreve-se o caso de paciente com síndrome parkinsoniana à direita, associada a disfunções cognitivas e síndrome de hipertensão intracraniana. A tomografia de crânio e o estudo angiográfico de vasos intracranianos demonstraram a presença de volumoso processo expansivo fronto-temporal esquerdo. A eletromiografia revelou tremor de repouso com frequência de 4 a 6 ciclos por segundo. A paciente foi submetida a ressecção cirúrgica da massa tumoral, cujo exame histológico revelou tratar-se de meningioma. A evolução pós-operatória foi excelente e após dois meses todas as anormalidades neurológicas haviam desaparecido. Um ano após a remoção do tumor a paciente permanecia assintomática sem uso de qualquer medicação. São discutidos aspectos fisiopatológicos do parkinsonismo por processo expansivo e as particularidades do presente caso são analisadas em confronto a dados da literatura.

SUMMARY

We are presenting an uncommon case of cerebral tumor whose major manifestation was parkinsonism. The patient was a 50-year-old woman presented with a 5-month history of tremor of the right hand, particularly at rest, and headache. On neurological examination of March, 1987 there were: slight right-sided hemiparesis with symmetrical hiperreflexia; discrete bradykinesia in combination with cogwheel rigidity also on the right-side; resting tremor of the right hand; and bilateral papilledema. The neuropsycho-logycal examination disclosed: nominative aphasia, impaired recent memory and right-left disorientation. The computed tomography showed a large, left frontotemporal tumor. Angiograms of the left internal and external carotid arteries revealed a tumor blush in the left frontotemporal region supplied by a enlarged middle meningeal artery. An electromyogram revealed a 4-6 HZ tremor on right hand. A course of treatment with dexametasone 16mg/day and levodopa plus benzerazine (500mg/day) was unsuccessful. A left fronto-temporo-parietal craniotomy was performed and an attached sphenoid wing tumor was mtacroseopically completely removed. Microscopy indicated that the tumor was a meningioma. Postoperativelly, the patient made an uneventful recovery. After two weeks, her right-sided palsy and parkinsonism had disappeared, and neuropsyehologyeal deficits improved. Two months later there was no abnormalities on neurological and neuropsyehologycal examination. It was concluded that the parkinsonism was caused by mechanical pressure on the basal ganglia.

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Dr. Egberto Reis Barbosa - Clínica Neurológica, Hospital das Clínicas, FMUSP - Caixa Postal 3461 - 01060 São Paulo SP - Brasil.

Referências bibliográficas

1. Bonduelle M, Lormeau G, Zalzal P. Tremblement d'attitude du membre superior gauche, révélateur d'un volumineux meningioma de la, faux contralateral (presentation de malade). Rev Neurol (Paris) 1970, 122:375-376.
2. Fahn S. Secundary parkinsonism. In Goldensohn ES, Appel SH (eds) : Scientific Approaches to Clinical Neurology. Philadelphia: Lea and Pebiger, 1977, p 1159-1189.
3. Garcia de Yebenes I, Gervas JJ, Iglesias J, Mena AA, Martin de Rio R, Somoza E. Biochemical findings in a case of parkinsonism secondary to brain tumor. Ann Neurol 1982, 11:313-316.
4. Hunt EL, Lisa JR. Frontal lobe tumor: a case simulating epidemic encephalitis with Parkinson's syndrome. J Am Med Ass 1927, 89:1674-1676.
5. Leenders KL, Findley LJ, Cleeves L. PET before and after surgery for tumor induced parkinsonism. Neurology 1986, 36:1074-1078.
6. Lhermitte F, Agyd Y, Serdaru M, Guimarães J. Syndrome parkinsonien, tumor frontale et L-DOPA. Rev Neurol (Paris) 1984, 140:138-139.
7. Musella R, Elvibge AR. Parkinsonian-like syndrome caused by cyst in posterior fossa. J Neurosurg 1964, 21:62-65.
8. Okada K, Nakashima H, Ishibashi A, Watanabe M, Kuramoto S. Parkinsonism associated with a brain tumor: a case of convexity meningioma. Kurume Med J 1983, 30:97-101.
S. Oliver L. Parkinsonism due to midbrain compression. Lancet 1959, 2:817-819.
10. Paker HL. Tumors of the brain simulating epidemic encephalitis and involving the third ventricle, the fourth ventricle, and the basal ganglia: report of three cases. J Nerv Ment Dis 1923, 58:1-15.
11. Polysoidis KS, McQueen JP, Rajput AH, McFadyn DJ. Parkinsonism as a manifestation of brain tumor. Surg Neurol 1985, 23:59-63.
12. Straube A, Sigel K. Parkinsonism syndrome caused by a tumour of the left supplementary motor area. Neurology 1988, 730-731.
13. de Vera Reyes JA. Parkinsonism-like syndrome caused by posterior fossa tumor. J Neurosurg 1970, 33:599-601.

Parkinsonismo associado a tumor cerebral relato de caso

Parkinsonism associated to brain tumor: case report.

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Set 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bonduelle M, Lormeau G, Zalzal P. Tremblement d'attitude du membre superior gauche, révélateur d'un volumineux meningioma de la, faux contralateral (presentation de malade). Rev Neurol (Paris) 1970, 122:375-376.

[2] 2. Fahn S. Secundary parkinsonism. In Goldensohn ES, Appel SH (eds) : Scientific Approaches to Clinical Neurology. Philadelphia: Lea and Pebiger, 1977, p 1159-1189.

[3] 3. Garcia de Yebenes I, Gervas JJ, Iglesias J, Mena AA, Martin de Rio R, Somoza E. Biochemical findings in a case of parkinsonism secondary to brain tumor. Ann Neurol 1982, 11:313-316.

[4] 4. Hunt EL, Lisa JR. Frontal lobe tumor: a case simulating epidemic encephalitis with Parkinson's syndrome. J Am Med Ass 1927, 89:1674-1676.

[5] 5. Leenders KL, Findley LJ, Cleeves L. PET before and after surgery for tumor induced parkinsonism. Neurology 1986, 36:1074-1078.

[6] 6. Lhermitte F, Agyd Y, Serdaru M, Guimarães J. Syndrome parkinsonien, tumor frontale et L-DOPA. Rev Neurol (Paris) 1984, 140:138-139.

[7] 7. Musella R, Elvibge AR. Parkinsonian-like syndrome caused by cyst in posterior fossa. J Neurosurg 1964, 21:62-65.

[8] 8. Okada K, Nakashima H, Ishibashi A, Watanabe M, Kuramoto S. Parkinsonism associated with a brain tumor: a case of convexity meningioma. Kurume Med J 1983, 30:97-101.

[9] S. Oliver L. Parkinsonism due to midbrain compression. Lancet 1959, 2:817-819.

[10] 10. Paker HL. Tumors of the brain simulating epidemic encephalitis and involving the third ventricle, the fourth ventricle, and the basal ganglia: report of three cases. J Nerv Ment Dis 1923, 58:1-15.

[11] 11. Polysoidis KS, McQueen JP, Rajput AH, McFadyn DJ. Parkinsonism as a manifestation of brain tumor. Surg Neurol 1985, 23:59-63.

[12] 12. Straube A, Sigel K. Parkinsonism syndrome caused by a tumour of the left supplementary motor area. Neurology 1988, 730-731.

[13] 13. de Vera Reyes JA. Parkinsonism-like syndrome caused by posterior fossa tumor. J Neurosurg 1970, 33:599-601.