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Images in Neurology
June 2008

Postencephalitic Hemiparkinsonism: Clinical Imaging Correlation

Arch Neurol. 2008;65(6):837. doi:10.1001/archneur.65.6.837

A 56-year-old woman presented with a 1-year history of nonprogressive gait disturbance. On examination she had marked parkinsonian features limited to the right side. Her symptoms started after a flulike illness that lasted 2 months and had manifested with sore throat, fever, severe fatigue, and sleepiness. Findings from her workup revealed a high titer of anti–Epstein-Barr virus IgG antibodies and a left substantia nigra lesion on her magnetic resonance imaging scan (Figure). The cerebrospinal fluid content was unremarkable. Findings from antistreptolysin O titer, West Nile serology, and cerebrospinal fluid oligoclonal bands testing were negative. The lesion seen on magnetic resonance imaging correlates with the clinical symptoms and likely represents a subtle postencephalitic scarring of the substantia nigra. Unlike previously published images,1 this finding is subtle and it may be missed if not looked for.