Contralateral myoclonus and bilateral parkinsonism after the ablation of a left frontal meningioma: A case report

We report a patient aged 63 years with no previous history of neurological disease who, soon after the successful ablation of a left frontal meningioma, developed abulia, a right upper motorneurone syndrome with mild anterior dysphasia, myoclonic jerks of the right upper limb, and mild bilateral parkinsonism. The patient had also generalized seizures and received antiepileptic treatment. A brain CT scan showed a focal left fronto-lateral lesion. Giant somatosensory evoked potentials were recorded over the left somatosensory cortex. The EEG showed spikes over the left hemisphere. The patient markedly improved with clonazepam, piracetam, and L-dopa. Myoclonus and the upper motor neurone syndrome on the right side are due to a focal lesion of the left sensory-motor cortex, but the bilateral L-dopa-responsive parkinsonism could arise from impaired frontal-lobe control over the basal ganglia motor circuit.