Objective: To report a case of parkinsonism secondary to amyloid angiopathy and discuss the pathophysiology and treatment of this entity.

Background: Cerebral amyloid angiopathy is characterized by the accumulation of an amyloid protein that builds up in the vessel walls of the brain, increasing thus the risk for hemorrhagic and ischemic stroke. We report the case of a 75-years-old male patient who developed parkinsonism with dyskinesia secondary to cerebral amyloid angiopathy.

Method: Mr B. is a 75-years-old male patient who developed progressive bilateral resting tremor and cognitive decline beginning at 68 years of age. His medical history revealed a poorly controlled systemic hypertension.The patient was diagnosed for parkinsonism and used Levodopa at 150 mg per day since then. Admitted for impaired consciousness with motor aphasia and right hemiparesis associated to sudden involuntary movements of the left shoulder. The neurological examination found dyskinesia of the left shoulder and the head with rigidity and bradykinesia in all limbs. Brain-MRI showed multiple, with different age, strokes and countless microbleeds especially in the basal ganglia region and posterior cranial fossa at the T2* weighted images

Results: During his hospitalization, the patient’s dyskinesia intensified and became bilateral in the both upper limbs and the head. Levodopa treatment was increased at an equivalent daily dose of 200 mg per day with a slight improvement.

Conclusion: In conclusion, amyloid angiopathy should be considered as a hypothesis in patients with high cardiovascular risk factors and abrupt onset of extrapyramidal movement disorders. Two types of abnormal involuntary movements can be seen after a stroke: transient or permanent.The difference is made upon their persistence in time. Neurologists must keep in mind that vascular parkinsonism can result from strokes involving the nigrostriatal pathway. The golden rule is to explore any abrupt or bilateral parkinsonism. Our patient was misdiagnosed as idiopathic Parkinson’s disease for several years, the sudden onset of dyskinesia concomitant with the stroke revealed the amyloid angiopathy as an etiology of his movement disorders. Treatment is mainly symptomatic, and includes dopamine replacement therapy and optimal management of the cardiovascular risk factors. A mild improvement of the dyskinesia and the parkinsonism is expected with this treatment as was the case of our patient.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/case-report-parkinsonim-with-dyskinesia-secondary-to-amyloid-angiopathy/