Parkinson’s syndrome after closed head injury: a single case report
- aThe National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, bDepartment of Clinical Neurology, Institute of Neurology, Medical Research Council, Human Movements and Balance Unit, Queen square, London, UK, cMRC Cyclotron Unit, Hamersmith Hospital, Ducane Road, London, UK
- Dr AJ Lees, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
- Received 12 March 1998
- Revised 29 June 1998
- Accepted 9 July 1998
Abstract
A 36 year old man, who sustained a skull fracture in 1984, was unconscious for 24 hours, and developed signs of Parkinson’s syndrome 6 weeks after the injury. When assessed in 1995, neuroimaging disclosed a cerebral infarction due to trauma involving the left caudate and lenticular nucleus. Parkinson’s syndrome was predominantly right sided, slowly progressive, and unresponsive to levodopa therapy. Reaction time tests showed slowness of movement initiation and execution with both hands, particularly the right. Recording of movement related cortical potentials suggested bilateral deficits in movement preparation. Neuropsychological assessment disclosed no evidence of major deficits on tests assessing executive function or working memory, with the exception of selective impairments on the Stroop and on a test of self ordered random number sequences. There was evidence of abulia. The results are discussed in relation to previous literature on basal ganglia lesions and the effects of damage to different points of the frontostriatal circuits.
