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Bilateral Parkinsonism: when to image?
  1. Vincenzo Levi1,
  2. Giulio Andrea Bertani1,
  3. Giorgio Carrabba1,
  4. Marco Locatelli1,
  5. Filippo Cogiamanian2,
  6. Paolo Rampini1
  1. 1Department of Surgery Division of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  2. 2Department of Neuroscience Division of Neurophysiopathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  1. Correspondence to Vincenzo Levi, Department of Surgery Division of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Francesco Sforza 33, Milan 20122, Italy; vincenzo.levi{at}unimi.it

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Clinical presentation

A 51-year-old man presented with a 1-year history of gait imbalance and difficulties in the execution of fine movements. On examination, he had hypomimia, bilateral and symmetrical bradykinesia and rigidity (unified Parkinson’s disease rating scale (UPDRS) =17). He had no tremor, impairment of eye movement and cerebellar or pyramidal signs.

MR scan of brain found a giant inter-hemispheric arachnoid cyst, exerting a moderate mass effect on the basal ganglia bilaterally (figure …

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