Unilateral abolition of extrapyramidal rigidity after ipsilateral cerebellar, infarction
✍ Scribed by J. Rivest; N. Quinn; J. Gibbs; Dr. C. D. Marsden
- Publisher
- John Wiley and Sons
- Year
- 1990
- Tongue
- English
- Weight
- 384 KB
- Volume
- 5
- Category
- Article
- ISSN
- 0885-3185
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✦ Synopsis
Rigidity is one of the cardinal clinical features of Parkinson's disease. It can be reversed not only by drugs such as dopamine agonists, but also by lesions involving the internal segment of the globus pallidus, the thalamus, or the final cortical motor output pathway, i.e., the pyramidal tract (1). We present a case in which a large cerebellar infarct abolished ipsilateral rigidity. This hitherto undescribed (to our knowledge) association may be of relevance in the understanding of the mechanisms underlying rigidity.
CASE REPORT
A lady suffered from moderate hypertension from age 62 and bilateral hemifacial spasm from age 65. At age 70, she gradually developed bilateral but predominantly left-sided parkinsonism, with akinesia, cogwheel rigidity (grade 2 on the Webster Scale), flexed posture, and a mild rest tremor. Brain computed tomography (CT) scan was normal. At age 72, she was started on levodopa plus benzeraside, increasing to "Madopar 250" three times daily and benzhexol, 2 mg four times daily, with a good and sustained response on follow-up examination. At age 73, she sustained a transient and mild left hemiparesis, lasting only a few hours.