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Enteroviral Postencephalitic Parkinsonism With Evidence of Impaired Presynaptic Dopaminergic Function

Michel Toledano, MD1,2; Nicholas W. S. Davies, PhD, FRCP2
[+] Author Affiliations
1Department of Neurology, Mayo Clinic, Rochester, Minnesota
2Department of Neurology, Charing Cross Hospital, Imperial College Healthcare National Health Service Trust, London, England
JAMA Neurol. 2016;73(8):1023-1025. doi:10.1001/jamaneurol.2016.1043.
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This case report describes a woman with enteroviral postencephalitic parkinsonism with impaired presynaptic dopaminergic function.

Postencephalitic parkinsonism is reported following infection with certain viruses such as Japanese B encephalitis virus, St Louis encephalitis virus, western equine encephalitis virus, eastern equine encephalitis virus, West Nile virus, Epstein-Barr virus, influenza A virus, and certain enteroviruses such as coxsackievirus B and echoviruses.1 These viruses affect the cortex, thalamus, brainstem, and spine, but preferential involvement of the substantia nigra (SN) has been reported.1,2 Postencephalitic parkinsonism with SN involvement has also been reported in cases of encephalitis lethargica (EL; von Economo disease),3,4 which occurred in epidemic form between 1915 and 1928. To our knowledge, although a viral etiology has long been suspected in EL, no infectious agent has ever been isolated.

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Magnetic Resonance Imaging (MRI) and Dopamine Transporter Scan Imaging

A, Coronal fluid-attenuated inversion recovery MRI 3 days after presentation showing signal change extending caudally from the midbrain to the pons. B, T2-weighted axial MRI 15 days later showing overall improvement and maturation of signal in the substantia nigra (SN), right (arrowhead) greater than left. C, T2-weighted axial MRI at 1 year demonstrating gliotic changes in the SN, right (arrowhead) greater than left. D, T2-weighted axial MRI demonstrating subtle signal abnormality in the bilateral basal ganglia at presentation. E, T2-weighted axial MRI showing no appreciable evolution or radiologic evidence of tissue destruction at 1 year. F and G, Dopamine transporter scan 3 weeks (F) and 1 year (G) after presentation showing reduced uptake in the right putamen and in the right greater than left putamen, respectively.

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