Parkinsonism due to predominant involvement of substantia nigra in Japanese encephalitis
- 1 November 1999
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 53 (8), 1781
- https://doi.org/10.1212/wnl.53.8.1781
Abstract
Objective: To study the clinical correlates of lesions seen predominantly in the substantia nigra in some patients with Japanese encephalitis (JE). Background: JE typically involves thalamus, brainstem, spinal cord, and cerebral cortex. Rarely, basal ganglia and cerebellum may be affected. Lesions are often widespread and discrete. Predominant involvement of substantia nigra in JE has not been previously reported. Methods: Of 52 patients with JE seen in an endemic zone, five were selected on the basis of isolated lesions in the substantia nigra on MRI; all were subjected to detailed clinical and laboratory evaluation. Results: Presenting symptoms were fever, alteration of consciousness, neck stiffness, and decreased body movements. Examination during acute illness revealed restricted eye movements, opsoclonus, upbeating nystagmus, and cogwheel rigidity. There was early and complete recovery of consciousness and eye signs. Parkinsonian features such as positive glabellar tap sign, masklike face, bradykinesia, tremors, and postural instability became apparent as these patients started walking. Reversible mutism was observed in three patients during the acute phase. Response to levodopa, amantadine, and trihexiphenedyl was partial. Three patients were followed for more than 1 year, during which time their parkinsonian features recovered completely. Substantial recovery was also observed in the two other patients 2 months after regaining consciousness. Conclusions: Some patients with Japanese encephalitis may have lesions predominantly in the substantia nigra. After recovery from acute encephalitic illness, they manifest clinically with typical parkinsonian features. Although several viruses are known to cause parkinsonism, this is the first demonstration of a virus producing lesions predominantly in the substantia nigra and causing parkinsonism.Keywords
This publication has 20 references indexed in Scilit:
- Parkinsonism with HIV infectionMovement Disorders, 1998
- Postencephalitic stereotyped involuntary movements responsive to L‐DopaMovement Disorders, 1996
- Virological investigations of acute encephalopathy in India.Archives of Disease in Childhood, 1990
- A follow-up study by CT and MRI in 3 cases of Japanese encephalitisNeuroradiology, 1990
- Changes in cerebral level of monoamines by Japanese encephalitis virus infection.Uirusu, 1989
- Japanese encephalitis: Immunocytochemical studies of viral antigen and Inflammatory cells in fatal casesAnnals of Neurology, 1985
- Kinetics of IgM and IgG Responses to Japanese Encephalitis Virus in Human Serum and Cerebrospinal FluidThe Journal of Infectious Diseases, 1985
- Host Defence Mechanisms Against Japanese Encephalitis Virus Infection in MiceJournal of General Virology, 1983
- Diagnosis and immediate prognosis of Japanese B encephalitisAmerican Journal Of Medicine, 1952