Slowly progressive Parkinson syndrome due to thalamic butterfly astrocytoma
- T. Wächter, MD*,
- M. Engeholm, MD*,
- S. Bisdas, MD,
- J. Schittenhelm, MD,
- T. Gasser, MD and
- R. Krüger, MD
- Address correspondence and reprint requests to Dr. Rejko Krüger, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; rejko.krueger{at}uni-tuebingen.de
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↵* These authors contributed equally.
A 74-year-old man had a 4-year history of slowly progressive asymmetric resting tremor, hypokinesia, rigidity, and postural instability and mild cognitive decline, initially diagnosed as Parkinson disease. Clinical response to levodopa was moderate (video on the Neurology® Web site at www.neurology.org). Additional pyramidal signs developed; cranial MRI showed a symmetric bilateral tumor of the thalamus and brainstem (figure, A and B). Biopsy revealed an anaplastic astrocytoma grade III (figure, C). Even though parkinsonism caused by a tumor is rare,1 brain imaging should be considered early when presenting with atypical clinical signs or poor levodopa response, so as to exclude potentially treatable structural causes.
MRI shows a thalamic butterfly-shaped tumor, including the cerebral peduncles and pons (A.a–A.b) without enhancement in T1-weighted images (A.c). Magnetic resonance (MR) spectroscopy shows markedly increased choline with decreased N-acetylaspartate peak and metabolic hot spot (B), suggestive of a high-grade glioma, verified by histopathology displaying glial fibrillary acid protein (GFAP)–positive tumor cells with mitoses and proliferative activity (C). FLAIR = fluid-attenuated inversion recovery.
Footnotes
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Supplemental data at www.neurology.org
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Author contributions: Tobias Wächter: drafting and revision of the manuscript, analysis and interpretation of data, acquisition of data, study coordination. Maik Engeholm: revision of the manuscript, study concept, analysis and interpretation of data, acquisition of data. Sotirios Bisdas: revision of the manuscript, analysis and interpretation of data, acquisition of data. Jens Schittenhelm: revision of the manuscript, analysis and interpretation of data, acquisition of data, Thomas Gasser: revision of the manuscript, study supervision. Rejko Krüger: revision of the manuscript, study concept and design, analysis and interpretation of data, acquisition of data, study supervision, and coordination.
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Disclosure: Dr. Wächter has received funding for travel and speaker honoraria from Medtronic, Inc., Solvay Pharmaceuticals, Inc., Abbott, Cephalon, Inc., and Schwarz Pharma; and holds stock in Gilead Sciences, Inc. Dr. Engeholm reports no disclosures. Dr. Bisdas serves on the editorial advisory board for Radiology Research and Practice. Dr. Schittenhelm has received research support from Merck Serono. Dr. Gasser serves on the editorial boards of Movement Disorders, Parkinsonism and Related Disorders, and the Journal of Neurology; holds a patent re: The LRRK2 gene and neurodegenerative disorders; serves as a consultant for Cephalon, Inc. and Merck Serono; serves on the speakers' bureaus of Novartis, Merck Serono, Schwarz Pharma, Boehringer Ingelheim, and Valeant Pharmaceuticals International; and receives research support from Novartis, the Federal Ministry of Education and Research (BMBF), the Helmholtz Association, and the European Union. Dr. Krüger has received speaker honoraria and/or funding for travel from UCB, Cephalon, Inc., Abbott, Takeda Pharmaceutical Company Limited, and Medtronic, Inc.; serves on the editorial advisory boards of the European Journal of Clinical Investigations, the Journal of Neural Transmission, and BMC Neurology; and receives research support from the German Research Council (DFG), the Michael J Fox Foundation, the Federal Ministry for Education and Research (BMBF), and the Medical Faculty of the University of Tübingen.
- Copyright © 2011 by AAN Enterprises, Inc.
