Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus

Background: Parkinsonism secondary to the treatment of obstructive hydrocephalus due to stenosis of the cerebral aqueduct, with implantation of a ventricular peritoneal (VP) shunt is a rare complication, still poorly described and disseminated in the literature. Case Description: A 38-year-old mal...

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Principais autores: Godeiro Junior, Clécio de Oliveira, Costa, André Corsino da, Pinheiro Júnior, Nilson, Fernandes, Ana Clara Aragão, Queiroz, Cítara Trindade de, Moura, Anaís Concepcion Marinho Andrade de, Aquino, Carlos Eduardo França de, Rego, Marianne de Araújo
Outros Autores: 0000-0002-4312-1633
Formato: article
Idioma:English
Publicado em: Scientific Scholar - Surgical Neurology International
Assuntos:
hydrocephalus
secondary Parkinson disease
ventriculoperitoneal shunt
Endereço do item:https://repositorio.ufrn.br/handle/123456789/52823
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spelling ri-123456789-528232023-06-21T20:31:27Z Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus Godeiro Junior, Clécio de Oliveira Costa, André Corsino da Pinheiro Júnior, Nilson Fernandes, Ana Clara Aragão Queiroz, Cítara Trindade de Moura, Anaís Concepcion Marinho Andrade de Aquino, Carlos Eduardo França de Rego, Marianne de Araújo 0000-0002-4312-1633 hydrocephalus secondary Parkinson disease ventriculoperitoneal shunt Background: Parkinsonism secondary to the treatment of obstructive hydrocephalus due to stenosis of the cerebral aqueduct, with implantation of a ventricular peritoneal (VP) shunt is a rare complication, still poorly described and disseminated in the literature. Case Description: A 38-year-old male presented a history of moderate-intensity daily headache, which deteriorated 2 months before admission, with no changes in the neurological examination. Magnetic resonance imaging showed hypertensive hydrocephalus associated with cerebral aqueduct stenosis. A VP shunt was performed, an adjustable pressure valve was successfully inserted, and he was discharged asymptomatic. However, months later, he progressed with important symptoms of hypo- and hyper-drainage, which persisted after valve pressure adjustments and even its exchange, culminating into an endoscopic third ventriculostomy (ETV). But soon after, severe Parkinsonian syndrome appeared. Therapy with levodopa and bromocriptine was initiated, revealing a slow response initially but good evolution within 6 months. At present, he presents low-intensity residual tremor, which is well controlled with medications, and has regained independence for daily activities, with minimal motor limitation and no cognitive changes. Conclusion: There is still no mechanism that explains the occurrence of Parkinsonian syndrome in these cases. It is suggested that the rostral portion of the midbrain was injured due to abrupt changes in the transtentorial gradient pressure after the ventricular shunt, along with various adjustments in the valve pressure. ETV and early introduction of levodopa therapy in patients who developed postventriculoperitoneal shunt Parkinsonism seems to be the most effective combination, with satisfactory clinical response in the medium/long term. 2023-06-21T20:31:12Z 2023-06-21T20:31:12Z 2021-08-30 article GODEIRO JUNIOR, Clécio de Oliveira; COSTA, André Corsino da; PINHEIRO JÚNIOR, Nilson; FERNANDES, Ana Clara Aragão; QUEIROZ, Cítara Trindade de; MOURA, Anaís Concepcion Marinho Andrade de; AQUINO, Carlos Eduardo França de; REGO, Marianne de Araújo. Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus. Surgical Neurology International, [S.L.], v. 12, p. 432, 30 ago. 2021. Scientific Scholar. http://dx.doi.org/10.25259/sni_629_2021. Disponível em: https://surgicalneurologyint.com/surgicalint-articles/parkinsonism-secondary-to-ventriculoperitoneal-shunt-in-a-patient-with-hydrocephalus/. Acesso em: 21 jun. 2023. https://repositorio.ufrn.br/handle/123456789/52823 10.25259/SNI_629_2021 en Attribution-NonCommercial-ShareAlike 3.0 Brazil http://creativecommons.org/licenses/by-nc-sa/3.0/br/ application/pdf Scientific Scholar - Surgical Neurology International
institution Repositório Institucional
collection RI - UFRN
language English
topic hydrocephalus
secondary Parkinson disease
ventriculoperitoneal shunt
spellingShingle hydrocephalus
secondary Parkinson disease
ventriculoperitoneal shunt
Godeiro Junior, Clécio de Oliveira
Costa, André Corsino da
Pinheiro Júnior, Nilson
Fernandes, Ana Clara Aragão
Queiroz, Cítara Trindade de
Moura, Anaís Concepcion Marinho Andrade de
Aquino, Carlos Eduardo França de
Rego, Marianne de Araújo
Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
description Background: Parkinsonism secondary to the treatment of obstructive hydrocephalus due to stenosis of the cerebral aqueduct, with implantation of a ventricular peritoneal (VP) shunt is a rare complication, still poorly described and disseminated in the literature. Case Description: A 38-year-old male presented a history of moderate-intensity daily headache, which deteriorated 2 months before admission, with no changes in the neurological examination. Magnetic resonance imaging showed hypertensive hydrocephalus associated with cerebral aqueduct stenosis. A VP shunt was performed, an adjustable pressure valve was successfully inserted, and he was discharged asymptomatic. However, months later, he progressed with important symptoms of hypo- and hyper-drainage, which persisted after valve pressure adjustments and even its exchange, culminating into an endoscopic third ventriculostomy (ETV). But soon after, severe Parkinsonian syndrome appeared. Therapy with levodopa and bromocriptine was initiated, revealing a slow response initially but good evolution within 6 months. At present, he presents low-intensity residual tremor, which is well controlled with medications, and has regained independence for daily activities, with minimal motor limitation and no cognitive changes. Conclusion: There is still no mechanism that explains the occurrence of Parkinsonian syndrome in these cases. It is suggested that the rostral portion of the midbrain was injured due to abrupt changes in the transtentorial gradient pressure after the ventricular shunt, along with various adjustments in the valve pressure. ETV and early introduction of levodopa therapy in patients who developed postventriculoperitoneal shunt Parkinsonism seems to be the most effective combination, with satisfactory clinical response in the medium/long term.
author2 0000-0002-4312-1633
author_facet 0000-0002-4312-1633
Godeiro Junior, Clécio de Oliveira
Costa, André Corsino da
Pinheiro Júnior, Nilson
Fernandes, Ana Clara Aragão
Queiroz, Cítara Trindade de
Moura, Anaís Concepcion Marinho Andrade de
Aquino, Carlos Eduardo França de
Rego, Marianne de Araújo
format article
author Godeiro Junior, Clécio de Oliveira
Costa, André Corsino da
Pinheiro Júnior, Nilson
Fernandes, Ana Clara Aragão
Queiroz, Cítara Trindade de
Moura, Anaís Concepcion Marinho Andrade de
Aquino, Carlos Eduardo França de
Rego, Marianne de Araújo
author_sort Godeiro Junior, Clécio de Oliveira
title Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
title_short Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
title_full Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
title_fullStr Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
title_full_unstemmed Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
title_sort parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
publisher Scientific Scholar - Surgical Neurology International
publishDate 2023
url https://repositorio.ufrn.br/handle/123456789/52823
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