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Japanese Encephalitis presenting with cerebral venous sinus thrombosis: a case report

Neo RJ

Med J Malaysia, 2019 12;74(6):537-539.
PMID: 31929482

A 17-year-old man from Sarawak presented with acute encephalitis syndrome. Serologic testing revealed raised Japanese Encephalitis (JE) IgM antibody titre in which first serum JE was negative followed by positive second serum JE IgM one week later. Magnetic resonance imaging (MRI) and Magnetic resonance venogram (MRV) showed cerebral venous sinus thrombosis (CVST) which is a rare presentation of JE. Early identification of CVST is important as anticoagulation needs to be started to reduce adverse neurological sequelae and improve prognosis.
Presynaptic Hemiparkinsonism Following Cerebral Toxoplasmosis: Case Report and Literature Review

Malaquias MJ, Magrinelli F, Quattrone A, Neo RJ, Latorre A, Mulroy E, et al.

Mov Disord Clin Pract, 2023 Feb;10(2):285-299.
PMID: 36825049 DOI: 10.1002/mdc3.13631

BACKGROUND: Cerebral toxoplasmosis (CTx) is a central nervous system opportunistic infection with variable neurological manifestations. Although tropism of Toxoplasma gondii for the basal ganglia is well known, movement disorders (MDs) represent only a small percentage of CTx-related neurological complications. CTx-associated MDs are usually hyperkinetic, whereas parkinsonism associated with evidence of presynaptic dopaminergic deficit has never been described.
CASE: We report a human immunodeficiency virus-positive patient who developed a complex MD featuring unilateral tremor combined with parkinsonism and dystonia following an acute episode of disseminated CTx. Her dopamine transporter scan (DaTscan) documented contralateral presynaptic dopaminergic deficit. Levodopa initiation improved both tremor and parkinsonism after ineffective trials of several other medications over the years.
LITERATURE REVIEW: A total of 64 patients presenting with CTx-related MDs have been described. The most common MD was chorea (44%), followed by ataxia (20%), parkinsonism (16%), tremor (14%), dystonia (14%), myoclonus (3%), and akathisia (2%). DaTscan was performed only in 1 case, of Holmes tremor, that demonstrated reduced presynaptic dopaminergic uptake. Positive response to dopaminergic treatment was reported in 3 cases of Holmes tremor and 2 cases of parkinsonism.
CONCLUSIONS: Presynaptic dopaminergic deficit may occur in CTx-related tremor combined with parkinsonism. Its identification should prompt initiation of levodopa, thus avoiding unnecessary trials of other drugs.
Fulltext A Reflection on Motor Overflow, Mirror Phenomena, Synkinesia and Entrainment

Quattrone A, Latorre A, Magrinelli F, Mulroy E, Rajan R, Neo RJ, et al.

Mov Disord Clin Pract, 2023 Sep;10(9):1243-1252.
PMID: 37772299 DOI: 10.1002/mdc3.13798

In patients with movement disorders, voluntary movements can sometimes be accompanied by unintentional muscle contractions in other body regions. In this review, we discuss clinical and pathophysiological aspects of several motor phenomena including mirror movements, dystonic overflow, synkinesia, entrainment and mirror dystonia, focusing on their similarities and differences. These phenomena share some common clinical and pathophysiological features, which often leads to confusion in their definition. However, they differ in several aspects, such as the body part showing the undesired movement, the type of this movement (identical or not to the intentional movement), the underlying neurological condition, and the role of primary motor areas, descending pathways and inhibitory circuits involved, suggesting that these are distinct phenomena. We summarize the main features of these fascinating clinical signs aiming to improve the clinical recognition and standardize the terminology in research studies. We also suggest that the term "mirror dystonia" may be not appropriate to describe this peculiar phenomenon which may be closer to dystonic overflow rather than to the classical mirror movements.
Neuropsychiatric Presentation of Anti-DPPX Progressive Encephalomyelitis with Rigidity and Myoclonus

Neo RJ, Mehta AR, Weston M, Magrinelli F, Quattrone A, Gandhi S, et al.

Mov Disord Clin Pract, 2024 Jan;11(1):97-100.
PMID: 38291842 DOI: 10.1002/mdc3.13928