Parkinsonian syndrome as a complication of systemic lupus erythematosus. Report of a case and review of the literature.

A 34-year-old woman has had systemic lupus erythematosus since 11 years, with multiple treatments and incomplete result. When examined in our department, she presented with a recent parkinsonian syndrome including bradykinesia, adiadochokinesia, cogwheel rigidity and postural tremor of hands. Deep tendon reflexes were increased. Brain MRI showed abnormal signal intensity in the periventricular white matter, internal capsule, brain stem, middle cerebellar peduncles and cerebellar hemispheres. She was treated with prednisone and mycophenolate for the lupus, and amantadine and benzhexol for the parkinsonian syndrome which resolved within ten months, while the lupus improved. There are 30 cases of Parkinson's disease as a complication of lupus reported in the literature. The pathogenesis may be cerebral vasculitis with ischemia, and antibodies against neurons, mainly dopaminergic. Twenty cases improved, eight of them with the treatment of the lupus alone.

Treatment of central pontine myelinolysis with thyrotropin-releasing hormone.

INTRODUCTION: Central pontine myelinolysis (CPM), demyelination of the brain stem, is a brain injury apparently due to osmotic forces. There is no consensus for its treatment. CASE: We describe here a case of CPM that occurred in a young patient after correction of hyponatremia, its treatment by intravenous thyrotropin-releasing hormone, and its outcome. DISCUSSION: Although very few instances of thyrotropin-releasing hormone treatment for CPM have been described, it appears to be effective and well tolerated. Studies are needed to assess its real efficacy.