Objective: To describe a case of secondary parkinsonism of unhabitual cause and complex treatment.

Background: Secondary parkinsonism constitutes approximately 15% of all parkinsonism cases in patients over 40 years old. In the literature, there have been reported few cases that CCM may be a cause of secondary parkinsonism.

We report a 72-years-old female patient with 11-years history of non-progressive right parkinsonism due to a CCM in the left substantia nigra (SN).

Method: In August 2012 patient had been complaining about resting tremor in the RUL for the past 3 years. The neurological examination revealed resting tremor in the right extremities with mild bradykinesia of the RLL. A brain SPECT with DaTscan revealed a decrease in presynaptic dopaminergic transporters in the left putamen. She was diagnosed of Parkinson’s disease and dopaminergic treatment was started with partial symptoms improvement. During the follow-up, a very slow symptoms progression was noticed in the right hemibody. In April 2021 she presented involuntary choro-ballistic movements of the right extremities of sudden onset. A Cranial CT revealed a left thalamo-capsular hematoma. There was favorable evolution with disappearance of involuntary movements. A Cranial MRI showed an old hematoma on the left subthalamic nucleus that seemed to be due to a CCM located in the left SN. Surgical treatment was ruled out due to the lesion location.

Results: In August 2022 she experienced another episode of involuntary movements in the right extremities. A CT revealed a new thalamo-mesencephalic hematoma. The involuntary movements persisted, so dopaminergic therapy was gradually withdrawn. There wasn’t reappearance of parkinsonian symptoms neither improvement in the hyperkinetic disorder. Treatment with risperidone was added with slight improvement. The CCM was successfully treated with radiotherapy. Another SPECT showed no changes compared to the previous one in 2012, so the final diagnosis of secondary parkinsonism of structural cause was established.

Conclusion: There are only four descriptions in the medical literature about secondary parkinsonism induced by CCM in basal ganglia. None of these cases have been clinically followed up for more than 10 years. This is the first report of parkinsonism due to CCM located in SN.

This is the second description in the literature about pathological DaTscan where we can find a secondary parkinsonism caused by CCM in the basal ganglia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hemiparkinsonism-secondary-to-a-cerebral-cavernous-malformation-ccm/