A Coincidental Case of Young-Onset Parkinson Disease and Multiple Sclerosis

Abstract

Parkinsonism in patients with multiple sclerosis is rare. Some patients have 2 coincidental diseases, whereas others have a Parkinsonian syndrome symptomatic to demyelinating lesions. We describe a 42-year-old female patient who developed left akinetic-rigid Parkinsonian syndrome at the age of 38 years. Brain magnetic resonance imaging revealed multiple white matter hyperintense T2-weighted lesions. DaTSCAN revealed reduced uptake of dopamine transporter in the right striatum. Intravenous corticosteroids were inefficacious. She had major clinical improvement with levodopa and 6 months later developed peak-dose dyskinesias. At the age of 41 years, she presented with a brainstem attack, with complete symptom resolution after intravenous corticosteroids. Subsequent brain magnetic resonance imagings disclosed new inflammatory lesions. Immunomodulatory treatment was started with β-interferon. In this patient, the presence of an asymmetrical Parkinsonian syndrome, with good response to levodopa, peak-dose dyskinesias, and abnormal DaTSCAN, supports the diagnosis of young-onset Parkinson disease. The multiple sclerosis diagnosis was established based on clinical evidence of time and space dissemination of demyelinating lesions.