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Video 4.1 A young boy with relapsed acute lymphocytic leukemia received cytosine arabinoside and methotrexate through an Omaya reservoir as a treatment for leukemic infiltration of the brain. Two weeks after receiving his infusion, he developed profound immobility and inability to swallow, and was admitted to hospital with a provisional diagnosis of a stroke. His level of consciousness and command following were completely of severe chemotherapy-induced parkinsonism was made, and treatment with levodopa resulted in marked improvement in swallowing and mobility. Eight months later in follow-up, he has residual moderate parkinsonism, with a shuffling gait and en bloc turn. An MRI of the brain revealed cystic necrosis of the substantia nigra. A fluoro-dopa PET scan confirmed bilateral reduction of uptake in the putamen, consistent with a pre-synaptic defect, and with his response to treatment with dopaminergic replacement. (MP4 129638 kb)
