Teaching NeuroImages: Parkinsonism Presenting With Watershed Pattern Lesions

A 47-year-old man presented to clinic with progressive right-hand bradykinesia and shuffling gait for 8 months. He was diagnosed with parkinsonism. Brain MRI demonstrated diffusion-weighted imaging (DWI)-hyperintense signal involving bilateral corona radiate (figure 1) and T2-weighted MRI showed white matter changes (figure 2). Colony-stimulating factor 1 receptor (CSF1R) gene sequencing revealed the pathogenic variant c.2381T>C(p.Ile794Thr), confirming the diagnosis of hereditary diffuse leukoencephalopathy with spheroids.(1) The patient was treated with levodopa and selegiline with minimal response.(2)

Automated summary

A 47-year-old man presented with progressive right-hand bradykinesia and shuffling gait, diagnosed with Parkinsonism and hereditary diffuse leukoencephalopathy. MRI findings confirmed the diagnosis, but treatment with levodopa and selegiline showed minimal response.