Acute Ischemic Stroke Presenting as Hemiparkinsonism: A Case Report

Abstract

Parkinsonism, commonly associated with Parkinson disease (PD), can also arise from other neurodegenerative disorders or non-neurodegenerative causes such as vascular parkinsonism (VP). This case highlights the acute onset of VP following a stroke, contributing to the understanding of VP’s varied presentations and the challenges in its diagnosis. A 54-year-old male with a history of cerebrovascular disease presented with behavioral changes and reduced activity, initially raising the suspicion of a central nervous system infection. Clinical findings included agitation, decreased social interaction, mutism, drooling, immobility, and rigidity. Imaging revealed acute infarction in the left cortical parieto-occipital region, caudate nucleus, and putamen, along with old infarcts, confirming VP. The primary diagnosis was vascular parkinsonism and he was started on anticoagulation therapy and levodopa/carbidopa, which showed minimal improvement over 6 months. This case underscores the importance of considering VP in patients with acute parkinsonian symptoms and a history of cerebrovascular disease. It highlights the necessity for prompt evaluation and management of vascular risk factors to optimize patient outcomes. Additionally, it emphasizes the need for a multidisciplinary approach in treating VP, given the limited efficacy of traditional Parkinson disease medications.