Objective: To describe a patient with parkinsonism secondary to an interpeduncular cistern cyst causing midbrain compression, highlighting clinical features, structural and molecular imaging findings, and surgical outcome.

Background: Parkinsonism is the most common hypokinetic movement disorder and is typically associated with neurodegenerative etiologies, such as Parkinson’s disease. In contrast, structural lesions causing compression of the basal ganglia or midbrain and resulting in parkinsonism are rare.

Method: A 53- year-old woman with a history of prediabetes presented with a one-year history of progressive parkinsonism, predominantly affecting the left side, with poor response to dopaminergic therapy. Brain MRI revealed a cystic lesion in the interpeduncular cistern causing midbrain compression.  The patient underwent endoscopic neurosurgical treatment via transnasal and transsphenoidal approach. Clinical assessment was performed using the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Brain MRI and PET imaging with 18F-DOPA were obtained before and after surgery. Case reporting followed CARE guidelines.

Results: Histopathological examination confirmed an epidermoid cyst. No surgical complications occurred. Postoperatively, the patient showed clinical improvement as measured by MDS-UPDRS scores. This improvement correlated with radiological decompression of the midbrain and increased presynaptic dopaminergic uptake on 18F-DOPA PET imaging.

Conclusion: Structural causes of parkinsonism are uncommon but potentially reversible. We report a case of an epidermoid cyst causing midbrain compression and disruption of the nigrostriatal pathways, demonstrated by structural and molecular imaging. Surgical decompression was associated with clinical improvement and recovery of presynaptic dopaminergic function.

Giant interpeduncular cyst pre and postoperative

Microscopic image of histological specimen

UPDRS III scale before and after surgery

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsonism-induced-by-an-interpeduncular-cistern-epidermoid-cyst-a-case-report-and-literature-review/