Dystonia-parkinsonism as the Presenting Feature of Hypothalamic Germinoma

Abstract

Abstract Background: Parkinsonism is more often caused by lesions affecting the basal ganglia but may also occur in lesions outside of this region. Case report: We report a case of a 17-year-old boy that presented with imbalance, slowing of movements, and abnormal posturing of the right arm. Neuroimaging revealed a lesion involving the right hypothalamus, with mild volume loss of the left thalamus and putamen. Discussion: Parkinsonism caused by brain tumors is very rare. To our knowledge there is no previous report of germinomas causing parkinsonism or dystonia. Most previously reported cases of parkinsonism secondary to tumors had a favorable outcome after tumor excision, but dopaminergic treatment was ineffective. This challenging case highlights the possibility of secondary causes for dystonia-parkinsonism and the possibility of lesions outside the main basal ganglia circuit presenting with parkinsonism.