Parkinsonism can rarely result from hypoxic ischemic injury. Different movement disorders including chorea, tics, athetosis, dystonia, and myoclonus have been reported. Patients can develop parkinsonism with or without dystonia weeks to months after the ischemic event (74). MRI findings include T1 hyper intensities in the basal ganglia bilaterally, indicative of ischemia or gliosis. In the case described by Li et al. (74), the clinical findings included mainly an akinetic rigid syndrome with hypomimia, limitation of down gaze, dysarthria, rigidity, postural tremor, slow rapid alternating movements, shuffling gait, start hesitation, and freezing of gait occurring 3 wk after an anoxic injury owing to cardiac arrest. There was no improvement with dopaminergic drugs. The autopsy examination showed multiple old infarcts with the presence of macrophages indicative of old hemorrhagic infarct in the basal ganglia.
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