Tardive parkinsonism in a bipolar patient: Post-mortem examination supports a physiological rather than pathological dysfunction

Authors: Won, Moon¹; Mikos, Ania²; Hurd, Mary³; Fernandez, Hubert¹; Eskin, Thomas⁴; Romrell, Janet¹; Okun, Michael¹

Source: Neurocase, Volume 15, Number 1, February 2009 , pp. 66-69(4)

Publisher: Psychology Press, part of the Taylor & Francis Group

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Abstract:

We describe a case of tardive parkinsonism in the setting of bipolar syndrome, and we offer pathological confirmation that idiopathic Parkinson disease was not the underlying etiology. A 74-year-old Hispanic woman with a history of bipolar disease was noted to have oro-buccal-lingual chorea and parkinsonian symptoms such as resting tremor, rigidity, bradykinesia, and gait disorder persisting several months after neuroleptic discontinuation. She had minor improvement in ambulation with levodopa treatment, and she significantly improved in ambulation only during her manic states. Examination of the subject's post-mortem brain revealed no explicit evidence of degeneration in substantia nigra or other brainstem centers, and no nigral or cortical Lewy bodies were present. Glial cytoplasmic inclusions (characteristic of multiple systems atrophy) and globose neurofibrillary tangles (seen in progressive supranuclear palsy) were not seen either. This patient's presentation was most consistent with neuroleptic-induced parkinsonism and tardive dyskinesia; the etiology was likely related to previous neuroleptic exposure.

Keywords: Tardive; Post-mortem; Mania; Parkinson disease; Movement disorder; Neuroleptic

Document Type: Research article

DOI: http://dx.doi.org/10.1080/13554790802613033

Affiliations: 1: Movement Disorders Center, Department of Neurology, McKnight Brain Institute/University of Florida, Gainesville, FL, USA 2: Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA 3: Department of Internal Medicine, University of Florida, Gainesville, FL, USA 4: Department of Pathology, University of Florida, Gainesville, FL, USA

Publication date: 2009-02-01

Tardive parkinsonism in a bipolar patient: Post-mortem examination supports a physiological rather than pathological dysfunction

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