Objective: To study the utility of DaTscan in anoxic brain injury.

Background: Parkinsonism is a clinical syndrome seen in Parkinson Disease (PD) which includes tremors, bradykinesia, rigidity, and gait disturbance. Secondary Parkinsonism is explained by a specific etiology. DaTscans are abnormal even in the earliest presentation of the PD associated with nigrostriatal degeneration [1], but little is known about their role in revealing dopaminergic deficits in parkinsonism secondary to non-degenerative causes.

Methods: A 26-year-old woman presented with right arm tremor and stiffness, slowed speech, difficulty swallowing, difficulty opening eyes, and gait disturbance. Two months prior to the presentation, the patient was admitted for a heroin induced cardiac arrest and subsequent anoxic brain injury (ABI) as evidenced on brain imaging. She had no notable neurological deficits at that time. One month after her discharge, she started having above symptoms. Physical examination showed increased tone on extremities with intermittent involuntary movements of the right arm, and severe eyelid apraxia. Her gait was wide based and unsteady. A brain MRI showed abnormal T 2 hyperintensity in the bilateral globus pallidus, posterior internal capsule, and caudate head (figure1), compatible with ABI. The DaTscan revealed markedly decreased radiotracer activity in the right putamen and slightly reduced activity in the right caudate head and left putamen, supporting the diagnosis of a parkinsonian syndrome.

Results: To the best of our knowledge, this is the first report of abnormal DaTscan in secondary parkinsonism caused by ABI. The development of this condition most likely reflects the vulnerability of the globus pallidus and the substantia nigra-pars-reticularis to hypoxia/ischemia. The clinical diagnosis of post-hypoxic Parkinsonism in our patient was based on her young age, no history of anticonvulsant or antipsychotic medicine use, no family history of movement disorders and development of parkinsonian symptoms after ABI. DaTscan verified dopaminergic deficits in this patient with secondary parkinsonism due to ABI and therefore guided our treatment with Carbidopa/Levodopa.

Conclusions: In conclusion, we suggest that DaTscan should be considered to evaluate parkinsonism features in the setting of ABI.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/abnormal-datscan-in-a-case-of-anoxic-brain-injury/