A case of Lewy body disease and anaplastic astrocytoma presenting with atypical parkinsonism.
A case of Lewy body disease and anaplastic astrocytoma presenting with atypical parkinsonism.
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DOI：
10.1111/neup.12848
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发表时间：
2022-12
期刊：
影响因子：
2.3
通讯作者：
Kobylecki, Christopher
中科院分区：
文献类型：
--
作者：
Leahy, Christopher B.;Robinson, Andrew C.;Jabbari, Edwin;Morris, Huw R.;Lally, Imogen;Djoukhadar, Ibrahim;Roncaroli, Federico;Kobylecki, Christopher
关键词：
我们报告一位因路易体病(LBD)与弥漫性间变性星形细胞瘤共存而患上不典型帕金森症的病人。患者表现为混合小脑和帕金森综合征，左旋多巴反应不全，自主神经衰竭。临床诊断为多系统萎缩(MSA)。根据共识诊断标准，MSA的支持性特征包括姿势不稳和早期跌倒、早期吞咽困难、锥体体征和口面部肌张力障碍。特发性帕金森病(IPD)的诊断有多种排除标准。左侧大脑半球、整个中脑和脑干的神经病理检查显示LBD，符合IPD的新皮质型，海马区硬化，间变性星形细胞瘤广泛的肿瘤浸润，但没有占位性病变的证据。MSA无病理特征。在这位病人中，非典型帕金森综合症的分类是困难的。合并肿瘤混淆了临床特征和病程，导致不典型的表现和MSA的诊断。我们认为最初的特征是由路易小体病理引起的，而进展和共济失调、锥体征和坠落则因星形细胞瘤的发生而加速。我们的病例反映了准确诊断非典型帕金森综合征的挑战，混淆了共同病理的可能性，以及需要尸检才能得出明确的诊断。
We report on a patient with atypical parkinsonism due to coexistent Lewy body disease (LBD) and diffuse anaplastic astrocytoma. The patient presented with a mixed cerebellar and parkinsonian syndrome, incomplete levodopa response, and autonomic failure. The clinical diagnosis was multiple system atrophy (MSA). Supportive features of MSA according to the consensus diagnostic criteria included postural instability and early falls, early dysphagia, pyramidal signs, and orofacial dystonia. Multiple exclusion criteria for a diagnosis of idiopathic Parkinson's disease (iPD) were present. Neuropathological examination of the left hemisphere and the whole midbrain and brainstem revealed LBD, neocortical‐type consistent with iPD, hippocampal sclerosis, and widespread neoplastic infiltration by an anaplastic astrocytoma without evidence of a space occupying lesion. There were no pathological features of MSA. The classification of atypical parkinsonism was difficult in this patient. The clinical features and disease course were confounded by the coexistent tumor, leading to atypical presentation and a diagnosis of MSA. We suggest that the initial features were due to Lewy body pathology, while progression and ataxia, pyramidal signs, and falls were accelerated by the occurrence of the astrocytoma. Our case reflects the challenges of an accurate diagnosis of atypical parkinsonism, the potential for confounding co‐pathology and the need for autopsy examination to reach a definitive diagnosis.
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影响因子：
8.6
作者：
Molho, ES
通讯作者：
Molho, ES
影响因子：
12.7
作者：
Attems J;Toledo JB;Walker L;Gelpi E;Gentleman S;Halliday G;Hortobagyi T;Jellinger K;Kovacs GG;Lee EB;Love S;McAleese KE;Nelson PT;Neumann M;Parkkinen L;Polvikoski T;Sikorska B;Smith C;Grinberg LT;Thal DR;Trojanowski JQ;McKeith IG
通讯作者：
McKeith IG
影响因子：
4.1
作者：
Koga, Shunsuke;Roemer, Shanu F.;Tipton, Philip W.;Low, Phillip A.;Josephs, Keith A.;Dickson, Dennis W.
通讯作者：
Dickson, Dennis W.
影响因子：
14.5
作者：
Miki, Yasuo;Foti, Sandrine C.;Holton, Janice L.
通讯作者：
Holton, Janice L.
影响因子：
9.9
作者：
Gilman, S.;Wenning, G. K.;Vidailhet, M.
通讯作者：
Vidailhet, M.