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NEUROLOGY 1992;42:1323
© 1992 American Academy of Neurology

Levodopa-nonresponsive Lewy body parkinsonism

Clinicopathologic study of two cases

M. H. Mark, MD, J. I. Sage, MD, D. W. Dickson, MD, K. O. Schwarz, MD and R. C. Duvoisin, MD

Departments of Neurology (Drs. Mark, Sage, and Duvoisin) and Pathology (Neuropathology) (Dr. Schwarz), University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ; and the Department of Pathology (Neuropathology) (Dr. Dickson), Albert Einstein College of Medicine, Bronx, NY.

We report two patients with a primarily akinetic form of parkinsonism who were nonresponsive to treatment with levodopa. At autopsy, both patients had many Lewy bodies in brainstem and diencephalic nuclei, with sparse Lewy bodies in association cortices and more numerous Lewy bodies in the limbic cortices, consistent with the transitional form of Lewy body disease. These cases emphasize that (1) Lewy body Parkinson's disease cannot be excluded on the basis of atypical presentation or levodopa nonresponsiveness, and (2) the clinicopathologic spectrum of Lewy body disease is varied.

Address correspondence and reprint requests to Dr. Margery H. Mark, Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, CN-19, New Brunswick, NJ 08903.

Received August 28, 1991. Accepted for publication in final form December 10, 1991.




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