To outline the importance of neuroimaging in cases of early Parkinson’s disease with subacute onset of progressive unilateral hand tremor.

Parkinsonism can be primary (idiopathic) or secondary in nature. Secondary parkinsonism can be due to metabolic disorders, intoxication, cerebrovascular disorders, head injuries, or infectious etiologies. Intracranial tumor is an established, but rare cause of secondary parkinsonism. We report a patient who presented with early parkinsonism and was subsequently found to have a large anterior cranial fossa meningioma with mass effect on neuroimaging.

We present an interesting case of large anterior cranial fossa meningioma with mass effect on the caudate presenting with secondary parkinsonism. This represents a mechanical compression of the basal ganglia without direct basal ganglia involvement.  To our knowledge, this is the first reported case of residual right-hand resting tremor despite surgical resection, which may indicate chronic damage to the basal ganglia from mass effect. These patients should be challenged with dopamine agonists to monitor their response to the treatment and assess future outcome.