J Korean Neurosurg Soc.  2012 Mar;51(3):144-146. 10.3340/jkns.2012.51.3.144.

Astrocytoma in the Third Ventricle and Hypothalamus Presenting with Parkinsonism

• Choi KH
• Choi SM
• Nam TS
• Lee MC

• KMID: 2018187
• DOI: http://doi.org/10.3340/jkns.2012.51.3.144

Abstract

Parkinsonism secondary to intracranial mass lesions usually results from compression or distortion of the basal ganglia. Secondary parkinsonism due to midbrain infiltration or compression is rare and generally associated with other neurologic signs caused by pyramidal tract and/or cranial nerve involvement. We report a case of 30-year-old woman in whom mild parkinsonism was the major clinical manifestation of an astrocytoma in the anterior third ventricle and hypothalamus. She underwent surgical resection, ventriculoperitoneal shunt and radiation therapy. All symptoms of parkinsonism were completely recovered 3 months after the treatment. Brain tumors can be manifested only by the symptoms of parkinsonism. This case emphasizes the significance of neuroimaging in the evaluation of parkinsonism.

Keyword

Astrocytoma; Brain tumor; Hypothalamus; Parkinsonism

MeSH Terms

Adult
Astrocytoma
Basal Ganglia
Brain Neoplasms
Cranial Nerves
Female
Humans
Hypothalamus
Mesencephalon
Neuroimaging
Neurologic Manifestations
Parkinson Disease, Secondary
Parkinsonian Disorders
Pyramidal Tracts
Third Ventricle
Ventriculoperitoneal Shunt

Figure

• 

  Fig. 1 Brain magnetic resonance imaging show diffuse astrocytoma in the anterior third ventricle and hypothalamus. Sagittal FLAIR image (A), T2-weighted axial image (B), and T1-weighted axial image after administration of gadolinium (C) show an ill-defined lesion with nodular enhancement, which involves the anterior third ventricle and bilateral hypothalamis (arrowhead). The images before treatment also show compression and inferiorly displacement of the midbrain including the substantia nigra by the tumor mass and obstructive hydrocephalus secondary to the tumor (arrow). The images after treatment with surgical excision and cerebrospinal fluid drainage show significant decrease of the tumor and lateral ventricles, and consequent improvement of midbrain compression (D, E and F).

• 

  Fig. 2 These photomicrographs are histopathologic findings of diffuse astrocytoma (WHO grade II). Higher magnification of the tumor shows a hypercellular lesion composed of cells with moderate plemorphism and chromatin density (A : H&E stain, ×200; B : H&E stain, ×100). Immunohistochemistry reveals diffuse positivity for GFAP in the tumor cells (C : avidin-biotin-peroxidase, ×200) compare with in the gliosis (D : avidin-biotin-peroxidase, ×200).

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