Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRN |
Texto Completo: | https://repositorio.ufrn.br/handle/123456789/52823 |
Resumo: | 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. |
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Godeiro Junior, Clécio de OliveiraCosta, André Corsino daPinheiro Júnior, NilsonFernandes, Ana Clara AragãoQueiroz, Cítara Trindade deMoura, Anaís Concepcion Marinho Andrade deAquino, Carlos Eduardo França deRego, Marianne de Araújo0000-0002-4312-16332023-06-21T20:31:12Z2023-06-21T20:31:12Z2021-08-30GODEIRO 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/123456789/5282310.25259/SNI_629_2021Scientific Scholar - Surgical Neurology InternationalAttribution-NonCommercial-ShareAlike 3.0 Brazilhttp://creativecommons.org/licenses/by-nc-sa/3.0/br/info:eu-repo/semantics/openAccesshydrocephalussecondary Parkinson diseaseventriculoperitoneal shuntParkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalusinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleBackground: 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.engreponame:Repositório Institucional da UFRNinstname:Universidade Federal do Rio Grande do Norte (UFRN)instacron:UFRNORIGINALParkinsonismSecondaryVentriculoperitoneal_GodeiroJunior_Etal_2021.pdfParkinsonismSecondaryVentriculoperitoneal_GodeiroJunior_Etal_2021.pdfapplication/pdf399227https://repositorio.ufrn.br/bitstream/123456789/52823/1/ParkinsonismSecondaryVentriculoperitoneal_GodeiroJunior_Etal_2021.pdf34dc5ba8de4293514ef1d06929659cc6MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81037https://repositorio.ufrn.br/bitstream/123456789/52823/2/license_rdf996f8b5afe3136b76594f43bfda24c5eMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-81484https://repositorio.ufrn.br/bitstream/123456789/52823/3/license.txte9597aa2854d128fd968be5edc8a28d9MD53123456789/528232023-06-21 17:31:27.84oai:https://repositorio.ufrn.br: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Repositório de PublicaçõesPUBhttp://repositorio.ufrn.br/oai/opendoar:2023-06-21T20:31:27Repositório Institucional da UFRN - Universidade Federal do Rio Grande do Norte (UFRN)false |
dc.title.pt_BR.fl_str_mv |
Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus |
title |
Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus |
spellingShingle |
Parkinsonism secondary to ventriculoperitoneal shunt in a patient with hydrocephalus Godeiro Junior, Clécio de Oliveira hydrocephalus secondary Parkinson disease ventriculoperitoneal shunt |
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 |
author |
Godeiro Junior, Clécio de Oliveira |
author_facet |
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_role |
author |
author2 |
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 |
author2_role |
author author author author author author author |
dc.contributor.authorID.pt_BR.fl_str_mv |
0000-0002-4312-1633 |
dc.contributor.author.fl_str_mv |
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 |
dc.subject.por.fl_str_mv |
hydrocephalus secondary Parkinson disease ventriculoperitoneal shunt |
topic |
hydrocephalus secondary Parkinson disease ventriculoperitoneal shunt |
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. |
publishDate |
2021 |
dc.date.issued.fl_str_mv |
2021-08-30 |
dc.date.accessioned.fl_str_mv |
2023-06-21T20:31:12Z |
dc.date.available.fl_str_mv |
2023-06-21T20:31:12Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
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. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufrn.br/handle/123456789/52823 |
dc.identifier.doi.none.fl_str_mv |
10.25259/SNI_629_2021 |
identifier_str_mv |
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. 10.25259/SNI_629_2021 |
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https://repositorio.ufrn.br/handle/123456789/52823 |
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Attribution-NonCommercial-ShareAlike 3.0 Brazil http://creativecommons.org/licenses/by-nc-sa/3.0/br/ |
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openAccess |
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Scientific Scholar - Surgical Neurology International |
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Scientific Scholar - Surgical Neurology International |
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