Objective: To show probable source of static performance of parkinsonism due to unknown atrophy of dominant hemisphere.

Background: Currently, world literature mentions many reasons causing symptoms of Parkinson’s disease, but the most difficulties in diagnosis and treatment is an exceptional form of secondary hypertonic hypokinetic syndrome. This message contains information about such rare case.

Methods: Full neurologic examination, Archimedes spiral test, MoCa test, UPDRS, Brain MRI.

Results: Patient Z., woman, right-hander, 43 years old was admitted to hospital with pain in the legs, arms, recurrent pain in the head, weakness and trembling of the right hand, sometimes of whole body, insomnia. 4 years is treated by a neurologist on a residence with a diagnosis of Parkinson’s disease and intervertebral disk herniation. History is not burdened. Treatment with L-dopa, amantadine, cyclodole were not effective. Constantly takes beta-blocker. Neurostatus – left hypoesthesia, central paresis of the facial nerve on the right, a frequent urge to urination, the tongue deviation to the right. Right hand has plastic hypertonicity, with active and passive tremor, active<passive. Retropulsion. Test of Archimedean spiral showed that type of spiral was Parkinsonik, the line is not smooth. MoCa test – 22 points. UPDRS – 30. In accordance to the criteria of UK Brain Bank Parkinson’s disease was excluded and changed to parkinosnism. But the absence of the effect of L-dopa, the sudden onset of the disease, the static features of clinics pushed us to seek the cause. MRI of the brain revealed – a significant reduction in the volume of the left hemisphere. The patient was recommended for DBS with diagnosis of parkinsonism with cryptogenic atrophy of dominant hemisphere. Origin of atrophy of dominant hemisphere stays unknown. Blood tests, meningeal symptoms – all normal.

Conclusions: The presence of the active tremor and Parkinson classic symptoms like hypoesthesia and sleep disturbances, predominance of passive tremor, on one hand and static course of the disease, resistance to therapy on the other creates differential diagnostic difficulties for the neurologist. Application of new neuroimaging techniques enable more specific diagnoses. In addition to improve the quality of life of the patient in the presence of refractory to standard treatment, and in the absence of dementia disorders DBS is shown.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mixed-tremor-with-cryptogenic-atrophy-of-dominant-hemisphere-diagnostic-and-treatment-challenges/