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Short report
Anticholinergic drugs: response of parkinsonism not responsive to levodopa
  1. H Yamada1,
  2. T Momose3,
  3. M Okada1,
  4. Y Kuroiwa2
  1. 1Department of Neurology, Yokohama City University, Medical Center, 4–57 Urafune-cho, Minami-ku, Yokohama 232–0024, Japan
  2. 2Department of Neurology, School of Medicine, Yokohama City University
  3. 3Department of Radiology, School of Medicine, Tokyo University, Tokyo, Japan
  1. Correspondence to:
 Dr H Yamada;
 hito1016{at}urahp.yokohama-cu.ac.jp

Abstract

A 41 year old man with parkinsonism and pyramidal signs is described. He was non-responsive to levodopa and dopamine receptor agonists but dramatically responded to trihexyphenidyl. In this patient, brain MRI showed bilateral hyperintensities along the corticospinal tracts on T2 weighted images. PET studies showed a decrease in 18F-6-fluorodopa uptake in the putamen contralateral to the more affected limbs and normal D2 receptor binding in the putamen. The PET and MRI findings and responsiveness to antiparkinsonian agents suggested degeneration of nigrostriatal dopaminergic neurons, striatal output pathways, and corticospinal tracts.

  • parkinsonism
  • positron emission tomography
  • trihexyphenidyl
  • FD18F-6-fluorodopa
  • UPDRS, unified Parkinson's disease rating scale
  • NMSP, 11C-N-methylspiperone

https://doi.org/10.1136/jnnp.72.1.111

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