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A CASE OF INTRACRANIAL MALIGNANT LYMPHOMA WITH PURE AKINESIA AND REPEATED REGRESSION ON CT SCANS Takeo Suzuki 1,4 , Mari Yamamoto 1 , Mitsunori Saitoh 1 , Akira Aoki 2 , Hisamasa Imai 3 , Hirotaro Narabayashi 3 1Department of Neurology, Kohnodai National Hospital 2Department of Neurosurgery, Kohnodai National Hospital 3Department of Neurology, Juntendo University School of Medicine 4Present Address : Department of Neurology, Juntendo University School of Medicine pp.689-696
Published Date 1984/7/1
DOI https://doi.org/10.11477/mf.1406205351
  • Abstract
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In a case of primary reticulum cell sarcoma in the brain, histologically verified by biopsy, the tumor regressed twice on a CT scan without radiotherapy. The systemic freezing phenomenon was seen as a main clinical symptom.

The patient, a 44 year-old male, first complained of decreased livido and festinating speech. He also showed frozen gait, micrographia, a decrease in spontaneity and urinary incontinence. Four months after onset he was hospitalized. Neurolo-gical findings on admission revealed freezing ofgait,writing, and speech, but there was no weak-ness of muscles with normal tendon reflexes, and normal muscular tone.

In the CT scan on admission, there were high density areas mainly in the head of the right caudate nucleus, the medial deep portion of the right frontal lobe, the right side of the hypo-thalamus, the anterior thalamus, the globus pallidus. There were also nodular-type enhanced effects in the same areas.Regression of the tumor was seen on the CT scans after administration of betamethasone. The tumor which had again in-creased in size regressed spontaneously without the use of steroids after 3 months. Thereafter, the tumor gradually became larger and an open biopsy was perfomed. Histopathological findings showed a reticulum cell sarcoma. There were no findings of systemic malignant lymphoma. Such intracrainal malignant lymphomas showing repeated regression including spontaneous one are very rare in the literature.

The freezing phenomenon in this case started with festinating speech and spread to writing and gait. L-DOPA had no effect. This systemic freez-ing phenomenon was considered to be the same as that in the cases of pure akinesia without rigidity and tremor reported by Narabayashi and Imai, which did not respond to L-DOPA at all. But on the other hand, L-Threo-3, 4-Dihydro-xyphenylserine was effective to the frozen gait of this patient.

From the clinical symptoms and repeated CT examinations, it was suggested that the frozen gait was related to the lesion in the head of the right caudate nucleus or its around areas on CT scans, while the urinary incontinence and decrease in spontaneity were related to the spread of the tumor into the medial deep portion of the frontal lobe or into the hypothalamus.

In the finger tapping test, the hastening pheno-menon described by Nakamura et al was seen on both sides, predominantly on the left side. With respect to the reaction time, there was prolongation of both the initiation and movement times on both sides, and there was a remarkable extension of the initiation time on the left side. The predo-minance of these disturbances of the left side suggested that the freezing phenomenon is closely related to the tumor lesion seen on the right side of the brain.

There have been no reports of pure akinesia due to the brain tumor, and the localized area of pathology responsible for this specific symptom has not been presented. The present case may suggest the important role of the head of caudate nucleus or its adjacent structures in generation of freezing symptoms.


Copyright © 1984, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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