Large intracranial meningioma masquerading as Parkinson's disease

A previously healthy 58-year-old right-handed woman presented with a 2-month history of progressive asymmetrical extrapyramidal symptoms and signs suggestive of idiopathic Parkinson's disease. The parkinsonian presentation may be a result of direct compressive effects on the basal ganglia (particularly the nigrostriatal structures) or disruptions to frontostriatal connections. 1 2 Recent functional imaging modalities have further characterised the importance of such connections. 3-5 Utilising H215O positron emission tomography Jahanshahi et al 5 outlined that the motor 'off' state of Parkinson's disease was associated primarily with increased activity of the left caudate nucleus, as well as that of the right lentiform nucleus and cerebellum.