TY  - JOUR
EP  - 299
TI  - Presynaptic Hemiparkinsonism Following Cerebral Toxoplasmosis: Case Report and Literature Review
SP  - 285
N2  - Background:
Cerebral toxoplasmosis (CTx) is a CNS opportunistic infection with variable neurological manifestations. While tropism of Toxoplasma gondii for the basal ganglia is well known, movement disorders (MDs) represent only a small percentage of CTx-related neurological complications. CTx-associated MDs are usually hyperkinetic, whereas parkinsonism associated with evidence of presynaptic dopaminergic deficit has never been described. /

Case:
We report an HIV-positive patient who developed a complex MD featuring unilateral tremor combined with parkinsonism and dystonia following an acute episode of disseminated CTx. Her DaTscan documented contralateral presynaptic dopaminergic deficit. Levodopa initiation improved both tremor and parkinsonism after ineffective trials of several other medications over the years. /

Literature review:
A total of 64 patients presenting with CTx-related MDs have been described. The most common MD was chorea (44%), followed by ataxia (20%), parkinsonism (16%), tremor (14%), dystonia (14%), myoclonus (3%) and akathisia (2%). DaTscan was performed only in one case, of Holmes tremor, that demonstrated reduced presynaptic dopaminergic uptake. Positive response to dopaminergic treatment was reported in three cases of Holmes tremor and two of parkinsonism. /

Conclusions:
Presynaptic dopaminergic deficit may occur in CTx-related tremor combined with parkinsonism. Its identification should prompt initiation of levodopa, thus avoiding unnecessary trials of other drugs.
AV  - public
VL  - 10
KW  - Cerebral toxoplasmosis
KW  -  movement disorders
KW  -  HIV
KW  -  presynaptic parkinsonism
KW  -  systematic review
JF  - Movement Disorders Clinical Practice
UR  - https://doi.org/10.1002/mdc3.13631
PB  - Wiley
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
IS  - 2
Y1  - 2023/02//
ID  - discovery10161676
A1  - Malaquias, Maria João
A1  - Magrinelli, Francesca
A1  - Quattrone, Andrea
A1  - Neo, Ray Jen
A1  - Latorre, Anna
A1  - Mulroy, Eoin
A1  - Bhatia, Kailash P
ER  -