Ali İNAL, Abdurrahman IŞIKDOĞAN, Mehmet KÜÇÜKÖNER, Ertuğrul UZAR, Faysal EKİCİ, Muhammed Ali KAPLAN, Zuhat URAKCI

Metoclopramide-induced parkinsonism due to bilateral basal ganglia and brain stem involvement in a patient with laryngeal carcinoma

Metoklopramid gibi antiemetik ilaçlara bağlı parkinsonizmve bazal ganglion tutulumu nadirdir. Ancak, bilateral bazalganglion ve beyin sapı tutulumu ilaca bağlı parkinsonizm hastalarında henüz bildirilmemiştir. Larinks kanseri olan 52 yaşındaki erkek hasta dosetaksel, sisplatin ve 5-fluorourasil (DCF) kemoterapisi ile tedavi edildi. Kemoterapinin ilk küründen 15 gün sonra şiddetli bulantı ve kusma şikayeti nedeniyle metoklopramid verildi. Metoklopramid tedavisinin 6. gününde parkinsonizm belirtileri gözlendi. Çekilen serebral MRG’de bilateral bazal ganglionlarda ve beyin sapında tutulum saptandı. Metoklopramid tedavisi derhal kesilerek ve ağızdan biperiden başlandı. Parkinsonizm bulguları bir ay sonra gerçekleştirilen kontrol muayenesinde neredeyse tamamen düzeldi. Hastaya daha sonraki kemoterapi tedavilerinde metoklopramid verilmedi. Üç ay sonra çekilen serebral MRG’de lezyonlar tamamen düzeldi. Kemoterapi ile tedavi edilen larinks kanserli hastada beyin sapı ve bazal ganglion tutulumu ile birlikte metoklopramidin indüklediği parkinsonizm çok nadir görülen bir durumdur. Klinik ve radyolojik iyileşme neden olan ilacın kesilmesi ve biperiden tedavisi ile gözlenmiştir.

Larinks kanserli hastada beyin sapı ve bazal ganglion tutulumu ile birlikte metoklopramidin indüklediği parkinsonizm

Parkinsonism and basal ganglion involvement due to an-tiemetic drugs, such as metoclopramide, is rarely encoun-tered. However, bilateral basal ganglia and brain steminvolvement has not yet been reported in patients withdrug-induced Parkinsonism.A 52-year-old male patient with laryngeal carcinoma was treated with docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy. Because of severe nausea and vomiting 15 days after the first course of chemotherapy, meto- clopramide was administered. Parkinsonism symptoms were observed on the 6th day of metoclopramide therapy. Cerebral MRI revealed bilateral basal ganglia and brain stem involvement. Metoclopramide therapy was promptly discontinued and oral biperiden was commenced. Par- kinsonism findings almost completely improved on his control examination performed after one month. He was not given metoclopramide during further chemotherapy courses. Cerebral MRI taken after three months revealed that the lesions have completely relieved. This is an extremely rare case of metoclopramide-induced parkinsonism together with brain stem and basal ganglion involvement in a patient with laryngeal carcinoma treated by chemotherapy. The clinical and radiological improve- ment was observed with the cessation of the causative drug and biperiden therapy.

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