Abstract Details

Title Demyelinating Disease Associated with Parkinsonism: A Case Report

Topic Multiple Sclerosis

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-109

Objective To report a case of parkinsonism developed in the context of relapsing remitting multiple sclerosis (RRMS).

Background Movement disorders, most commonly action tremor, can develop in the context of multiple sclerosis (MS). However, parkinsonism occurring coincidentally with MS is uncommon and there is debate on whether this co-occurrence is causal or coincidental. Single photon emission computed tomography with Ioflupane I123 (conventionally known as a DaTscan) has not been reported as part of this evaluation. Herein, we demonstrate a case of parkinsonism with verified dopamine dysfunction on DaTscan that may be attributable to RRMS.

Design/Methods A chart review was performed of a patient who had clinical and radiographic features of parkinsonism and demyelinating disease.

Results A 59-year-old woman presented for increased tone and dystonia in the right lower extremity after a fall. Neurological exam revealed mild action tremor on right, no resting tremor, pronounced bradykinesia bilaterally, shuffling gait, rigidity and hyperreflexia in upper and lower extremities, right leg spasticity. UPDRS score was 39. There was no improvement with dopaminergic agents. MRI brain revealed T2 hyperintensities in the periventricular white matter and left lentiform nuclei without contrast enhancement. CSF analysis revealed the presence of oligoclonal bands and an IgG index of 1.34. DaTscan demonstrated scintigraphic evidence of a pre-synaptic striatal dopaminergic deficit in the left caudate and bilateral putamen. With additional history of attacks of weakness prior to her presentation, her clinical presentation fit the criteria for RRMS.

Conclusions We present an unusual case of parkinsonism co-occurring with multiple sclerosis, and the only reported case to our knowledge confirming dopamine dysfunction via radiographic study. We postulate that dopamine dysfunction may be the result of demyelinating disease targeting the deep cortical gray matter of the basal ganglia or the nigrostriatal pathways embedded in the white matter.

Authors/Disclosures
Zachary B. Jordan, MD (Ohio State University Wexner Medical Center) PRESENTER	Dr. Jordan has nothing to disclose.
Barbara Changizi, MD	Dr. Changizi has nothing to disclose.

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