Parkinsonism due to Fahr’s disease with previous carbon monoxide intoxication

摘要: We report a 72 year male patient who presented with progressive gait disturbance, starting hesitation and difficulties turning around himself, which appeared in the last few years. In his neurological examination, we found short step anteflexion hesitation, mild masked face, micrography upward gaze palsy. At age of 34, was hospitalized because comatose state due to carbon monoxide (CO) intoxication, initial critical care management included cardiopulmonary resuscitation. Since then he complained movement synchronization. He has been treated lacidipine, atenolol metformin arterial hypertension diabetes mellitus. Brain computed tomography (CT) magnetic resonance (MRI) showed necrotic lesions both caudate nuclei calcifications basal ganglia (Figs. 1, 2). Wilson’s disease, hypoparathyroidism, pseudohypoparathyroidism hyperparathyroidism were excluded. His laboratory work-up elevated values glucose (9.1 mmol/L), triglycerides (2.06 total cholesterol (5.04 mmol/L) LDL (3.5 mmol/L). Symptomatic treatments L-dopa dopamine agonist not successful. Our case demonstrates markedly delayed onset progression parkinsonism previous poisoning that did respond conventional therapy. Most likely, Fahr’s disease according radiological clinical findings. However, diagnostic criteria are completely fulfilled, there is history toxic exposure no positive family [1]. Progressive supranuclear palsy-like phenotype associated striopallidodentate calcification [2]. Carbon intoxication one most common fatal accidental [3]. Parkinsonism present 10 % patients poisoning, it usually CO encephalopathy [4]. The neuroradiological findings variable but globus pallidus white matter on brain MRI these [5]. Calcifications have reported after cases palidus they extensive [6, 7]. our case, probably caused by small possibly intoxication. substantia nigra injury role pathophysiology CO-induced [8]. conclusion, impressive radiographic findings, long interval between CO-intoxication drug-resistant parkinsonism, identified as primary cause. picture further influenced probable consequence & Hrvoje Budincevic hbudincevic@gmail.com