Ipsilateral blepharospasm and contralateral hemidystonia and parkinsonism in a patient with a unilateral rostral brainstem– thalamic lesion: Structural and functional abnormalities studied with CT, MRI, and PET scanning

Abstract

A patient developed progressive right hemidystonia in childhood. Subsequently, left‐sided blephaospasm, slurred and stuttering speech, and right‐sided rigidity and bradykinesia, responsive to dopamine agonists, appeared. Investigation with computed tomography and magnetic resonance imaging (MRI) at age 43 years revealed a left‐sided calcified rostral brainstem‐thalamic lesion of uncertain aetiology. Although no structural lesion was seen in the striatal regions, L‐[¹⁸F]‐fluorodopa uptake was severely diminished in the left striatum but normal on the right. Dopamine receptor binding identified by [¹¹C]‐methylspiperone was in the normal range on both sides.