Table E-1. Characteristics of Published Cases of Midbrain Lesion Presenting As Parkinsonism

Supplementary tables

Table e-1. Characteristics of published cases of midbrain lesion presenting as parkinsonism

Ref No. / Reference / Sex / Latency of AIMs onset / AAO of AIMs, year / Follow-up length / Type of lesion / Involved structures in midbrain / More than midbrain lesion§ / Representative AIMs / Pism / Other AIMS / Other neurologic deficit / Response to DA* / DAT imaging†
1 / Hardy, et al. 1957 / M / Nd / 11 / Nd / Syringomesencephalia / SN / x / Hemiparkinsonism / o, Rt / x / Rt arm weakness / Nd / ND
2 / Hunter et al. 1978 / M / Nd / 67 / 4Y / Stroke / SN / x / Hemiparkinsonism / o, Rt / x / x / Nd / ND
3 / Cheshire, et al. 1990 / F / 4M / 29 / 3Y / Trauma / SN, lateral tegmentun of mesencephalon, med & ventral trigeminal lemisci / x / Hemiparkinsonism / o, Rt / x / x / Nd / ND
4 / Fuente-Fernandez, et al. 1994 / F / <2M / 70 / Nd / Stroke / Cerebral peduncle, SN / x / Hemiparkinsonism / o, Rt / x / Peduncular hallucinosis, Rt hyperreflexia / Nd / ND
5 / Abe, et al. 1996 / F / 1M / 53 / 2Y / Hemorrhage / Cerebral peduncle, SN / Hemiparkinsonism / o, Rt / x / x / Yes / ND
6 / Peters, et al. 2001 / M / 0 / 56 / Nd / Stroke / Cerebral peduncle btw SN and RN / x / Hemiparkinsonism / o, Rt / x / Bilateral interal malleoli hypesthesia, areflexia in Rt ankle / No / Ipsilesional decrease
7 / Goldstein, et al. 2001 / F / 7Y / 35 / Nd / AVM / SN, cerebral peduncle / Thalamus / Hemiparkinsonism / o, Rt / x / Hyperreflexia, Rt / Yes, mild / Ipsilesional total loss
8 / Yoshimura, et al. 2002 / F / Nd / 63 / 5Y / Tumor / Cerebral peduncle, SN, RN / x / Hemiparkinsonism / o, Rt / x / Hyperreflexia, Rt / Yes / Ipsilesional decrease
9 / Morgan, et al. 2003 / F / <5D / 65 / >2M / Stroke / SN, RN / x / Hemiparkinsonism / o, Rt / x / Transiently impaired adduction of Lt eye / Yes / ND
10 / Orimo, et al. 2004 / F / 2M / 64 / 3Y / Storke / SN, RN / Middle cerebellar peduncle / Hemiparkinsonism / o, Lt / x / x / Yes / Ipsilesional total loss with D2 receptor up-regulation
11 / Krause, et al. 2005 / F / Nd / 63 / 2Y / Cystic lesions / Cerebral peduncle, SN, RN / x / Hemiparkinsonism / o, Rt / x / x / Yes / Ipsilesional decrease
12 / Ruzicka, et al.2005 / F / 0 / 19 / 3Y / Hemorrhage / SN, RN / x / Hemiparkinsonism / o, Rt / x / Mild Rt hemiparesis / Yes (fluctuation, dyskinesia) / ND
13 / Ohta, et al. 2006 / M / Nd / 57 / 18M / Stroke / SN / x / Hemiparkinsonism / o, Lt / x / x / Yes / Ipsilesional decrease
14 / Alarcon, et al. 2009 / M / 3 or 10M / Nd / Nd / Stroke / Mesencephalon / Pons / Hemiparkinsonism / o, Rt / ? / ? / Nd / ND
15 / Boecker, et al. 1996 / F / 0 / 71 / Nd / Suspicious stroke / Bilateral SN(Lt>Rt) / x / Parkinsonism (Rt>Lt) / o / x / x / Yes (dyskinesia) / Bilateral decrease (Lt>Rt)

AAO, age at onset; AIMs, abnormal involuntary movements; Pism, parkinsonism; D, days; M, months; Y, years; SN, substantia nigra; RN, red nucleus; Rt, right; Lt, left; ND, not done; Nd, not described; AVM, arteriovenous malformation

§More than midbrain lesions include the described lesion in basal ganglia, thalamus, subthalamus, pons, medullar or cerebellar peduncles.

*DA indicates levodopa or dopamine agonists.

†DAT imaging means 18F-FDOPA-PET or dopamine transporter imaging.

Table e-2 Characteristics of published cases of midbrain lesion presenting as tremor

Ref No. / Reference / Sex / Latency of AIMs onset / AAO of AIMs, year / Follow-up length / Type of lesion / Involved structures in midbrain / More than midbrain lesion§ / Representative AIMs / Pism / Other AIMS / Other neurologic deficit / Response to DA* / DAT imaging†
16 / Leung, et al. 1999 / M / Nd / 42 / Nd / Cavernoma with hemorrhage / Cerebral peduncle, SN, RN / Thalamus, upper pons / Holmes' tremor, Lt / x / x / Rt cerebellar sign/ CN III palsy, downward gaze palsy of Rt eye / No / ND
17 / Alusi, et al. 1999 / F / 21Y / 34 / Nd / AVM / Cerebral peduncle, SN, RN / x / Holmes' tremor, Rt / x / Dystonia / Rt hemiparesis/ hyperreflexia/ ataxia, dysarthria, pathologic laughing / Yes / ND
18 / Remy, et al. 1995 / F / 2Y / 29 / Nd / Head trauma / Cerebral peduncle, SN, RN / Thalamus / Tremor, Lt / x / Dyskinesia / Rt hemiparesis/ dysmetria, transient Rt. CN III palsy / Yes / Ipsilesional decrease
M / 2Y / 39 / Nd / Trauma (Bullet) / Upper peduncle level / x / Tremor, Rt / x / x / Hemiparesis, hypesthesia, Lt. CN III palsy / Yes / Ipsilesional decrease
M / 2M / 46 / Nd / Stroke / SN, RN / x / Tremor, Rt, / o, Rt / Dystonia / Lt hemiparesis, hypertonia, bradykinesia / Yes, partial / Ipsilesional decrease
M / 7M / 25 / Nd / Stroke on AVM / Cerebral peduncle, SN, RN / Thalamus / Tremor, Lt / o, Lt / x / Rt hemiparesis/ CN III palsy / Yes / Ipsilesional decrease
M / 1Y / 53 / Nd / Stroke / RN / Thalamus / Tremor, Lt / o, Lt / Dystonia / Transient Rt. 3rd nerve palsy/ hypertonia / Yes / Ipsilesional decrease
M / 22M / 30 / Nd / Head trauma / SN, RN / Subthalamic region / Tremor, Rt / x / x / Lt hemiparesis/ dysmetria/hypertonia / Yes, partial / Ipsilesional decrease
19 / Kudo, et al. 2001 / F / 2Y / 67 / Nd / Cavernoma with hemorrhage / RN, mesencephalic tegmentum, (SN: uncertain) / Inferior olivary nucleus hypertrophy, pons / Holmes' tremor, Rt , head tremor / x / x / Lt hemiparesis/ hypesthesia/ataxia/ hyperreflexia, dysarthria & dysphagia / Yes, minimal / ND
20 / Pathwa, et al. 2002 / F / 3M / 42 / Nd / Cavernoma with hemorrhage / Cerebral peduncle, SN, RN / x / Holmes' tremor, Lt / o, Lt / x / Lt hemiparesis/ hypesthesia/ataxia, Rt. CN III palsy / Yes, mild / ND
21 / Samadani, et al. 2003 / M / Nd / 24 / Nd / Cavernoma with hemorrhage / Midbrain / x / Holems's tremor, Rt, truncal tremor / x / x / INO, horizontal gaze palsy, ocular paramyoclonus, ataxia / Nd / ND
22 / Inci, et al. 2007 / F / Nd / 50 / 2M / Cavernoma w/o hemorrhage / Thalamomesencephalic junction , RN / Thalamus / Holmes' tremor, Lt / x / x / x / Nd / ND
23 / Zhong, et al. 2007 / F / Nd / 32 / 1Y / Cavernoma w/o hemorrhage / Cerebral peduncle, SN / x / Holmes' tremor, Lt / x / x / Rt CN III palsy, Lt. hemiparesis / No / ND
24 / Strecker, et al. 2007 / M / 5M / 52 / 23M / Abscess / Cerebral peduncle, SN, RN / x / Holems's tremor, Rt / x / x / Lt CN III palsy, Rt. hemiparesis, Rt facial hemihypesthesia / Yes / Ipsilesional decrease
25 / Lee, et al. 2008 / M / Nd / 58 / Nd / AVM, unrupatured / Midbrain lesion near SN / x / Rest tremor, Lt / x / x / Postural tremor of Rt hand / Yes / ND

AAO, age at onset; AIMs, abnormal involuntary movements; Pism, parkinsonism; M, months; Y, years; SN, substantia nigra; RN, red nucleus; Rt, right; Lt, left; ND, not done; Nd, not described; AVM, arteriovenous malformation; CN, cranial nerve; INO, internuclear ophthalmoplegia

§More than midbrain lesions include the lesion in basal ganglia, thalamus, subthalamus, pons, medullar or cerebellar peduncles.

*DA indicates levodopa or dopamine agonists.

† DAT imaging means 18F-FDOPA -PET or dopamine transporter imaging.

Table e-3 Characteristics of published cases of midbrain lesion presenting as dystonia

Ref No. / Reference / Sex / Latency of AIMs onset / AAO of AIMs, year / Follow-up length / Type of lesion / Involved structures in midbrain / More than midbrain lesion§ / Representative AIMs / Pism / Other AIMS / Other neurologic deficit / Response to DA* / DAT imaging†
26 / Dietl, et al. 1982 / M / Nd / 55 / 3W / Paraneoplastic encephalitis / From midbrain to caudal part of medullar oblongata / Cerebellar degeneration / Lock-jaw, dystonia of the right arm / x / x / Horizontal gaze palsy, ataxia, dysphagia, hyporeflexia / Nd / ND
27 / Leenders, et al. 1986 / M / Nd / 7 / Nd / Calcified lesion of uncertain aetiology / Ventral aspect of rostral brainstem (intact SN) / Equivocal thalamic lesion / Lt blepharospasm, Rt hemidystonia / o, Rt / x / Dysarthria / Yes for pism (dyskinesia) / Ipsilesional decrease
28 / Vidailhet, et al.1999 / M / 2M / 39 / Nd / Stroke / RN, superior cerebellar peduncle, ventral tegmental area, nigrostriatal fiber / Thalamus, medial subthalamic area / Dystonia, Rt / o, Rt / x / Rt hemiparesis/ hypesthesia, aphasia / Yes for rigidity, mild / Ipsilesional decrease
F / 3M / 66 / Nd / Stroke / RN, superior cerebellar peduncle, ventral tegmental area, nigrostriatal fiber / Thalamus, medial subthalamic area / Dystonia, Lt / o, Rt / x / Lt cerebellar sign, ataxia, dysarthria, Parinaud syndrome / Nd / Bilateral decrease‡
F / <1W / 51 / Nd / Stroke / RN, superior cerebellar peduncle, ventral tegmental area, nigrostriatal fiber§ / x / Dystonia, Lt / x / x / Lt cerebellar sign, Rt. CN III palsy / Nd / normal
M / <1W / 55 / Nd / Stroke / RN, superior cerebellar peduncle, ventral tegmental area, nigrostriatal fiber / x / Dystonia, Rt / x / x / Rt cerebellar sign, Lt CN III palsy / Nd / Ipsilesional decrease
M / 5M / 54 / Nd / Stroke / RN, SN, superior cerebellar peduncle, central tegmental tract / Thalamus / Dystonia, Rt / o, Rt / Tremor / Hypesthesia of Rt arm, diplopia, Lt cerebellar sign / Yes for tremor and pism / Ipsilesional decrease
M / <1Y / 17 / Nd / Stroke / RN, SN, superior cerebellar peduncle, central tegmental tract / Thalamus / Dystonia, Lt / o, Lt / Tremor / Lt cerebellar sign/hemiparesis / Yes for tremor and pism / Ipsilesional decrease
M / 18M / 55 / Nd / Stroke / Superior cerebellar peduncle / Superior cerebellar hemisphere / Dystonia, Rt / x / Cerebellar tremor / Rt cerebellar sign/ hypesthesia / Nd / normal
29 / Momjian-Mayor, et al. 2008 / F / 32Y / 34 / Nd / Stroke / Ventral midbrain, SN, cerebral peduncle / x / Dystonia, Rt / x / x / x / No / Ipsilesional total loss
30 / Loher, et al. 2009 / M / 3M / 31 / 9Y / Hemorrhage / Lateral and paramedian pontomesencephalic tegmentuma/tectum, RN, superior cerebellar peduncle / Pons / Lt hemidystonia, cervical dystonia, orofacial dystonia, / x / Lt & head tremor / Vegetative crisis, CN VI & VII palsy / Nd / ND
F / 14M / 43 / 14M / Posttraumatic hemorrhage / Medial and paramedian pontomesencephalic tegmentum/temtum / Pons / Lt hemidystonia, cervical dystonia / x / x / Vegetative crisis, upward/horizontal gaze palsy / Nd / ND
F / 6M / 4 / 24Y / Diffuse axonal injury with large brainstem lesion / Lateral pontomesencephalic tegmentum, RN / Pons / Cervical dystonia / x / Rt hemidystonia, tremor / CN VII palsy / Nd / ND
M / 1M / 56 / 3Y / Hemorrhage / RN / Lateral and paramedian pontine tegmentum, middle cerebellar peduncle / Blepharospasm, Cervical dystonia / x / bilateral & head tremor, Lt hemidystonia / Upward/horizontal gaze palsy, CN V & VII palsy / Nd / ND

AAO, age at onset; AIMs, abnormal involuntary movements; Pism, parkinsonism; W, weeks; M, months; Y, years; SN, substantia nigra; RN, red nucleus; Rt, right; Lt, left; ND, not done; Nd, not described; CN, cranial nerve

§More than midbrain lesions include the lesion in basal ganglia, thalamus, subthalamus, pons, medullar or cerebellar peduncles.

*DA indicates levodopa or dopamine agonists.

† DAT imaging means 18F-FDOPA -PET or dopamine transporter imaging.

‡ This lesion crossed the midline.

¥Questionable involvement of the superior cerebellar peduncle, ventral tegmental area and nigrostriatal fiber

Table e-4 Characteristics of published case of midbrain lesion presenting as chorea

AAO, age at onset; AIMs, abnormal involuntary movements; Pism, parkinsonism; D, days; Y, years; SN, substantia nigra; Lt, left; ND, not done; Nd, not described

§More than midbrain lesions limitedly include the lesion in basal ganglia, thalamus, subthalamus, pons, medullar or cerebellar peduncles. The lesion in the other structures was not mentioned here.

*DA indicates levodopa or dopamine agonists.

† DAT imaging means 18F-FDOPA -PET or dopamine transporter imaging.

References of supplementary tables

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