424 - Rehabilitation for a Patient with Parkinson's Disease and Frontal Brain Tumor: A Case Study

Case Diagnosis: Parkinson’s disease with concomitant brain tumor (meningioma)

Case Description: A 75-year-old man with mood disorder demonstrated upper limb tremors and generalized motoric slowing. He was diagnosed with PD on the basis of clinical examination. His tremor improved with medical treatment. Over the next year, he had a slow functional decline, despite participating in a Parkinson’s rehabilitation program. He had progressive problems with initiation. His family was looking into nursing home placement.

Eighteen months after his PD diagnosis, he developed acute onset of right sided weakness. Imaging demonstrated a large bifrontal brain tumor, consistent with meningioma. The tumor was surgically removed. He stabilized medically and came to ARU on hospital day 17.

Discussions: He made impressive functional gains. His right sided weakness improved. He progressed from requiring maximum assistance with transfers and ambulation to modified independent with the use of a rollator. He began participating in therapies and other activities, then began demonstrating near-normal initiation. He had resolution of previously unreported disturbing visual hallucinations. He became independent with self-cares. He still had his tremors and some motoric slowing, and continued to require assistance with IADLs. He discharged to the community with support from his family.

Conclusions: Concurrent presence of Parkinson’s disease and frontal meningioma is rare but, as this case demonstrates, can have devastating effects. Tumor-related damage to this patient’s frontal and prefrontal cortex contributed to his motoric, cognitive, and behavioral impairments. Plus, it disrupted frontostriatal connections, worsening his PD. The additive effects on mood and initiation threatened his very ability to function.



This case suggests that brain imaging, while not a standard component of PD diagnosis, should be considered when patients have unexpected or worsening symptoms. The case also demonstrates that interdisciplinary care and therapies were safe and effective, even in the setting of severe initiation impairments which can so often derail rehabilitation plans.