Objective:

 This report aims to present a case of atypical parkinsonism that is secondary to recurrent deep vein thrombosis with associated intracranial dural fistula.

Background: We present a middle-aged male who was admitted to neurology to complete the study due to bilateral and symmetrical parkinsonism that had been present for one year. The patient also experienced cognitive dysfunction and headache. 

Examination revealed significant reduction in facial expressions, as well as bilateral bradykinesia and rigidity on both sides of the body, right plantar cutaneous reflex indifferent, left extensor, shuffling gait in both feet with absence of tremor.

Method: MRI and angioMRI are performed which objectifies deep vein thrombosis and later after performing arteriography, the presence of dural fistula with Borden 1 classification is detected.

Results: The patient underwent a lumbo-peritoneal shunt and received oral anticoagulation. However, he experienced a new episode of venous thrombosis, which was complicated by temporal venous infarction and clinically presented with aphasia. 

Subsequent neurological follow-ups revealed stereotyped episodes indicating focal discognitive crises, as well as alterations in facial recognition. A new cranial MRI was performed, which revealed a new episode of epicranial venous sinuses, despite oral anticoagulation . Additionally, ophthalmological assessment detected severe bilateral optic atrophy.

Conclusion: A structural neuroimaging test is essential in all parkinsonisms, especially in young patients and even more so if atypical data appear, since it is essential to rule out treatable causes such as tumours or deep vein thrombosis. 

In the case of our patient, the clinical evolution was torpid despite correct management and the introduction of oral anticoagulation.

Angiography 2018

FLAIR + gadolinium

DWI

TOF

Magnetic susceptibility sequence

Angiography 2023

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MDS Abstracts - https://www.mdsabstracts.org/abstract/atypical-parkinsonism-secondary-to-recurrent-deep-vein-thrombosis-with-associated-intracranial-dural-fistula/