Sieve-like basal ganglia: A rare MRI presentation of vascular parkinsonism

摘要

An 87-year old male patient, a chronic tobacco chewer with long-standing diabetes mellitus and hypertension as well as history of two episodes oftransient ischemic attacks in the recent past, presented with rapid loss of mobility due to marked rigidity in both lower limbs causing severe posturalinstability along with hypophonic speech and severe bradykinesia due to which he become chair-bound over a period of 2 months. These featureswere predominantly consistent with lower-body parkinsonism. There was no history of fluctuations in his cognition status, hallucinations,myoclonus, gaze restriction, or postural drop. Possibility of vascular parkinsonism, normal pressure hydrocephalus, or frontal lobe tumor werekept. Magnetic resonance imaging revealed a multi-infarct state of the basal ganglia, which presented an almost sieve-like appearance on axialplanes [Figure 1]. There was no evidence of any hydrocephalus or a frontal lobe mass lesion on imaging. Finally, the clinico-radiological featureswere consistent with the diagnosis of vascular Parkinsonism.