Reversible parkinsonism due to a large intracranial tumour

Abstract

A 77-year-old woman presented with progressively worsening apathy, depression, urinary incontinence and slowness of movement for the past 1 year. Asymmetric akinetic-rigid parkinsonism and mild left-sided hyper-reflexia were seen on examination. No ocular movement impairment, cerebellar or sensory signs were noticed. Routine laboratory testing was normal. Brain imaging revealed a large frontal tumour which was subsequently excised and pathologically confirmed as a meningioma. Marked clinical improvement was documented 3 months after surgery, and persistent clinical and imaging remission have been confirmed annually for the following 3 years. There have been some reports of parkinsonism associated with intracranial tumours. Although this is probably an uncommon situation, it is potentially treatable, and symptoms might even remit completely following successful management. Parkinson's disease is a common cause of parkinsonism, but alternative aetiologies should be suspected whenever atypical findings are demonstrated by clinical history or examination.

Figure 1

Large right frontal intracranial tumour (large arrows) with surrounding oedema, compressing and displacing the ipsilateral striatum (small arrows). (A) preoperative CT scan; (B) and (C) preoperative axial T2-weighted MRI (B) more caudal than (C); (D) axial T2-weighted MRI 3 months after surgery.