Meningioma‑associated parkinsonism related to basal ganglia and cerebellar motor circuits: A case report and literature review

Abstract

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 ¹²³I-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.

Keywords: DAT SPECT; basal ganglia; cortico-cerebellar-cortical pathway; dentato-rubro-olivary pathway; meningioma; parkinsonism.

Figure 1

Timeline of the patient's clinical course. MRI, magnetic resonance imaging; MDS-UPRDS, Movement Disorder Society-Unified Parkinson's Disease Rating Scale.

Figure 2

Preoperative magnetic resonance imaging showing homogenous enhancement of the tumor. (A) Axial T2-weighted images revealed dilated tortuous veins. (B) Axial and (C) coronal contrast-enhanced T1-weighted images revealing compression of the right basal ganglia. (D) Dopamine transporter single-photon emission computed tomography showing decreased ¹²³I-ioflupane uptake in the right striatum.

Figure 3

Postoperative magnetic resonance imaging showing homogenous enhancement of the tumor. (A) Axial and (B) coronal contrast-enhanced T1-weighted images after the initial surgery revealing compression of the right basal ganglia. (C) Intraoperative findings. The tumor does not invade the brain and shows a clear borderline (*).

Figure 4

After the second surgery, (A) axial and (B) coronal magnetic resonance imaging reveal that the tumor no longer compresses the right basal ganglia.