Dopamine transporter (DAT) scan is important in the diagnosis of Parkinson's disease (PD). We herein report a patient with vascular parkinsonism (VP) who showed dopamine transporter (DAT) scan findings which mimicked those typically seen in patients with Parkinson's disease (PD). DAT scan findings in patients with VP are characterized by a lower striatal asymmetry index than in patients with PD and decreased uptake in the area consistent with old cerebral infarction or hemorrhage. However, we should be aware that, as in our patient, VP patients with asymmetric basal ganglia lesions, may show increased striatal asymmetry index and asymmetric DAT scan findings.
Waldenström macroglobulinemia (WM) is a B-cell lymphoproliferative malignancy characterized by IgM paraproteinemia and presence of lymphoplasmacytic cells in the bone marrow. Isolated longitudinally extensive transverse myelitis (LETM) is a rare manifestation of WM. We report a rare case of paraneoplastic LETM in a 68-year-old male with treatment-naïve WM (MYD88 L265P mutation in bone marrow aspirate), who responded to ibrutinib and venetoclax therapy. Our patient presented with a two-month history of unsteadiness, tingling, and numbness in both hands and feet, that progressed to bilateral leg and arm weakness. Based on radiographic findings, a diagnosis of paraneoplastic LETM was made and he was treated acutely with IV methylprednisolone followed by a quick oral prednisone taper. However, he subsequently relapsed and symptomatically worsened while on rituximab therapy. Accounting for worsening anemia, our patient was enrolled in a Phase II trial evaluating the effects of ibrutinib-venetoclax therapy in treatment naïve WM. After three months of study therapy, he had a complete response of myelopathy symptoms and MRI lesions. Our observation of sustained disease response in this patient may support a role for concurrent BTK and BCL2 inhibition in paraneoplastic myelitis associated with B-cell lymphoproliferative disorders. However, this observation needs to be validated in larger cohort studies and potentially in clinical trials if further data are supportive.

