摘要：

目的 探讨脑积水脑室-腹腔分流术后帕金森综合征的临床表现、影像学特点、可能的发病机制和治疗方法。方法与结果 共3 例脑积水患者均行脑室-腹腔分流术，1 例于第2 次术后1 个月出现帕金森综合征，再次行脑室-腹腔分流术后症状缓解不明显，予左旋多巴和苄丝肼；1 例于术后17 年出现颈部僵直、动作迟缓，予舒必利后短期内症状明显加重，停药后无改善；1 例于术后5 个月出现言语减少、动作迟缓，予奥氮平后症状明显加重。3 例患者头部CT 和（或）MRI 均显示侧脑室呈扩大-缩小波动性变化，临床诊断为帕金森综合征（脑室-腹腔分流术后），予左旋多巴和苄丝肼后症状明显缓解。结论 帕金森综合征是脑积水脑室-腹腔分流术后罕见并发症，可能是侧脑室扩大-缩小波动性变化引起黑质纹状体通路损害所致，予多巴胺D2 受体阻断剂可因“双重打击”致短期内帕金森样症状加重。多数患者多巴胺能药物治疗有效。

关键词: 脑积水, 脑室腹膜分流术, 手术后并发症, 帕金森障碍

Abstract:

Objective To explore the clinical presentations, imaging features, probable pathogenesis and therapy of parkinsonism following ventriculoperitoneal shunt (VPS) in hydrocephalus. Methods and Results There were 3 cases of parkinsonism following VPS in hydrocephalus. Case 1 presented parkinsonism one month after the second ventricular shunt, which was not relieved by another VPS, and was then treated by levodopa and benserazide. Case 2 developed neck rigidity and bradykinesia 17 years after VPS. Symptoms worsened shortly after taking sulpiride and did not improved with sulpiride cessation. Bradykinesia and decreased speech occurred 5 months after VPS in Case 3, and parkinsonism aggravated rapidly on the following day after taking olanzapine. CT and/or MRI of 3 cases showed fluctuating change (enlarging-shrinking) of lateral ventricles. They were diagnosed as parkinsonism following VPS, and responded well to levodopa and benserazide. Conclusions Parkinsonism, a rare complication following VPS in hydrocephalus, may result from interruption of nigrostriatal pathways due to ventricular fluctuations. Administration of dopamine D2 receptor antagonist may exacerbate the symptoms of parkinsonism because of "double hit". Most patients are responsive to dopaminergic drugs.

Key words: Hydrocephalus, Ventriculoperitoneal shunt, Postoperative complications, Parkinsonian disorders