Table 3.
A brief summary of patients with hypokinetic movement disorders emergencies
| Acute parkinsonism (n=4) | Description |
|---|---|
| Malignant subthalamic nucleus deep brain stimulation (STN-DBS) withdrawal syndrome (n=2) | Two patients of advanced Parkinson’s disease with motor fluctuations and levodopa induced dyskinesias who had undergone bilateral STN-DBS presented with acute parkinsonism due to implantable pulse generator (IPG) drainage. Both patients improved with IPG replacement. |
| Multiple neurocysticercosis (NCC) (n=1) | A 53-year-old man presented with acute onset of tremors in the left upper and lower limb, with bradykinesia, mask-like face, and decreased volume of speech. His gait was short-stepped with decreased arm swing and stooped posture. MRI brain showed multiple NCC in bilateral cerebral hemispheres, basal ganglia, thalamus, and cerebellum. |
| Osmotic demyelination syndrome (n=1) | A 55-year-old lady presented with repeated vomiting and had hyponatremia which was corrected. She presented to emergency room with bradykinesia, rigidity, mask-like face, decreased blink rate, and decreased volume of speech. MRI brain was suggestive of extrapontine myelinolysis/central pontine myelinolysis. |
| Serotonin syndrome (n=1) | A 51-year-old man was on fluoxetine and olanzapine for his behavioral disturbances since many years. The fluoxetine dose was increased recently from 60 mg/day to 80 mg/day. He developed tremors of all limbs, hallucinations, and myoclonus. On examination, he had tachycardia, diaphoresis, tremors, myoclonic jerks with brisk deep tendon reflex, and ankle clonus. There was improvement after cessation of fluoxetine. |
| Neurolept malignant syndrome (NMS) (n=1) | A 20-year-old man came with fever, tachycardia, urinary incontinence, and extrapyramidal symptoms with stupor on a background history of recent use of olanzapine for behavioral symptoms. Serum creatine kinase levels were elevated. He was managed with adequate hydration, stoppage of olanzapine, and started on levodopa. There was significant improvement in the symptoms with the normalization of creatine kinase levels. |