Parkinsonism Syndrome Due to Acute Bilateral Basal Ganglia Injury in A Diabetic Uremic Patient

Kezban Aslan; Meltem Demirkıran; Deniz Yerdelen; Mustafa Balal

Kezban Aslan¹, Meltem Demirkıran¹, Deniz Yerdelen², Mustafa Balal³

¹Department Of Neurology, Cukurova University, Faculty Of Medicine, Adana, Turkey
²Department Of Neurology, Baskent University, Faculty Of Medicine, Adana, Turkey
³Department Of Nephrology, Cukurova University, Faculty Of Medicine, Adana, Turkey

Keywords: chronic renal failure, parkinsonizm, bilateral basal ganlion lesion

Abstract

Scientific BACKGROUND: Extrapyramidal syndromes such as myoclonus and tremor are well-known complications of uremic encephalopathy, but parkinsonizm is a rare finding of this disease. In this study in relation to a diabetic üremic patient with bilateral basal ganglia lesion, we aimed to discuss movement disorders secondary to uremic encephalopathy.

CASE: This 50-year-old man had poorly controlled diabetes mellitus for 10 years. He also had a history of chronic renal failure requiring dialysis for 2 years. Four months before presenting to our hospital, he had developed involuntary movements in his arms which subsided in a month. Subsequently he developed gait difficulty and slowness of movement. Neurological examination revealed parkinsonizm syndrome. His blood urea and creatinine levels were high and cerebral MRI showed bilateral hyperintense lesions over the basal ganglia area on T2-weighted images. The patient’s therapy was continued with hemodialysis. His cerebral MRI findings showed improvement in the subsequent follow-up peformed 2 months later. His neurological findings did not improve, therefore he was placed on antiparkinsonian therapy. His parkinsonian signs gradually got better after L-Dopa treatment.

CONCLUSION: Parkinsonizm as well as hyperkynetic movement disorder may develop in patients with diabetic uremia due to bilateral basal ganglia lesion. These patients clinical improvements do not always correlate with the improvement on MRI.