Parkinsonian Syndromes Associated with Hydrocephalus

Received 2/20/2002; accepted 3/25/2002. For correspondence or reprints contact:Yi-Hsin Weng, M.D., Movement Disorders Unit, First Department of Neurology, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan, R.O.C. Tel: (886)3-3281200 ext. 8414, Fax: (886)3-3971504 Hydrocephalus is often characterized by gait disturbance, cognitive dysfunction, and/or urinary incontinence in the elderly. Parkinsonian syndromes associated with hydrocephalus are not uncommon. The pathogenesis is still unclear and the diagnosis is based on clinical observations. To investigate the nigrostriatal involvement in parkinsonian syndromes associated with hydrocephalus, we studied single photon emission computed tomography (SPECT) imaging with [2-[[2-[[[3(4-chlorophenyl)-8-methyl-8-azabicyclo [3.2.1] oct-2-yl] methyl] (2-mercaptoethyl) amino] ethyl] amino] ethanethiolato (3-)-N2,N2’,S2,S2’]oxo-[1R-(exo-exo)][Tc]technetium (Tc-TRODAT-1) in two cases of hydrocephalus associated with marked parkinsonism. One case showed asymmetric rigidity with gait disturbance. Another case showed tremor, rigidity, akinesia but only mild gait disturbance. None of them had dementia or incontinence. Magnetic resonance imaging (MRI) of brain revealed non-obstructive hydrocephalus. The parkinsonian features didn’t response to levodopa treatment but improved after shunting procedures in both cases. Tc-TRODAT-1 SPECT imaging revealed no significant reduction of Tc-TRODAT-1 uptake in both the caudate and putamen. It suggested that the presynaptic dopaminergic deficit was not the cause of parkinsonian syndromes associated with hydrocephalus in our patients. The report is the first report to discuss the function of the dopamine transports by SPECT imaging in the patients of hydrocephalus. We concluded that Tc-TRODAT-1 SPECT imaging might be useful in differential diagnosis of parkinsonian syndromes secondary to hydrocephalus and idiopathic Parkinson’s disease.