Parkinsonism following ventriculoperitoneal shunt for treating hydrocephalus:clinical analysis on three cases

Objective To explore the clinical presentations, imaging features, probable pathogenesis and therapy of parkinsonism following ventriculoperitoneal shunt (VPS) in hydrocephalus. Methods and Results There were 3 cases of parkinsonism following VPS in hydrocephalus. Case 1 presented parkinsonism one month after the second ventricular shunt, which was not relieved by another VPS, and was then treated by levodopa and benserazide. Case 2 developed neck rigidity and bradykinesia 17 years after VPS. Symptoms worsened shortly after taking sulpiride and did not improved with sulpiride cessation. Bradykinesia and decreased speech occurred 5 months after VPS in Case 3, and parkinsonism aggravated rapidly on the following day after taking olanzapine. CT and/or MRI of 3 cases showed fluctuating change (enlarging-shrinking) of lateral ventricles. They were diagnosed as parkinsonism following VPS, and responded well to levodopa and benserazide. Conclusions Parkinsonism, a rare complication following VPS in hydrocephalus, may result from interruption of nigrostriatal pathways due to ventricular fluctuations. Administration of dopamine D2 receptor antagonist may exacerbate the symptoms of parkinsonism because of "double hit". Most patients are responsive to dopaminergic drugs. DOI: 10.3969/j.issn.1672-6731.2017.02.008