Autoimmune-mediated secondary-parkinsonism presented with micrographia and cognitive impairment

Ning-Ning Che; Si-Yuan Chen; Xue Li; Jian-Jun Ma; Hong-Qi Yang

doi:10.1016/j.jneuroim.2021.577738

Autoimmune-mediated secondary-parkinsonism presented with micrographia and cognitive impairment

J Neuroimmunol. 2021 Dec 15:361:577738. doi: 10.1016/j.jneuroim.2021.577738. Epub 2021 Oct 5.

Authors

Ning-Ning Che¹, Si-Yuan Chen², Xue Li², Jian-Jun Ma², Hong-Qi Yang³

Affiliations

¹ Department of Neurology, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou 450003, China; Department of Neurology, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China.
² Department of Neurology, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou 450003, China.
³ Department of Neurology, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou 450003, China; Department of Neurology, Henan Provincial People's Hospital, School of Clinical Medicine, Zhengzhou University, Zhengzhou 450003, China. Electronic address: ericyng@163.com.

PMID: 34628132
DOI: 10.1016/j.jneuroim.2021.577738

Abstract

Parkinson's disease is a neurodegenerative disorder while secondary-parkinsonism can be caused by infectious, inflammatory, traumatic, vascular, hereditary, paraneoplastic, or even induced by drug/metal poisoning. Here we report an uncommon subacute parkinsonism who presented with micrographia and mild cognitive impairment. The CSF examination showed inflammatory profile and positive anti-NMDAR antibody. The patient showed no improvement with levodopa/benserazide administration but satisfactory response to immunotherapy with methylprednisolone. This case indicated that autoimmune etiology should also be considered in parkinsonism to exclude a treatable condition.

Keywords: Anti-NMDAR antibody; Cognitive impairment; Micrographia; Parkinsonism.

Publication types

Case Reports

MeSH terms

Adult
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications*
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / immunology
Antiparkinson Agents / therapeutic use
Autoantibodies / cerebrospinal fluid*
Benserazide / therapeutic use
Cognitive Dysfunction / etiology*
Drug Combinations
Fever of Unknown Origin / etiology
Handwriting*
Humans
Immunosuppressive Agents / therapeutic use
Immunotherapy*
Levodopa / therapeutic use
Male
Methylprednisolone / therapeutic use
Neuropsychological Tests
Parkinson Disease, Secondary / diagnosis
Parkinson Disease, Secondary / drug therapy
Parkinson Disease, Secondary / immunology*
Parkinson Disease, Secondary / psychology
Tremor / etiology

Substances

Antiparkinson Agents
Autoantibodies
Drug Combinations
Immunosuppressive Agents
anti-NMDA receptor autoantibody
benserazide, levodopa drug combination
Levodopa
Benserazide
Methylprednisolone