Parkinsonism in a Patient With Metal on Metal Total Hip Replacement Related Elevated Serum Heavy Metal Levels

Heavy metal toxicity accounts for a rare minority of parkinsonian presentations. It is established that metal on metal total hip replacements can elevate serum cobalt and chromium levels. Here, we present an atypical parkinsonism presentation in a patient with metal on metal total hip replacement related heavy metal exposure, a picture complicated by a previous cerebral vascular accident involving the right lentiform nucleus. Initial work-up included MRI brain and dopamine transporter uptake imaging. A follow-up consultation revealed progressing parkinsonism. This case presentation reports the first parkinsonism presentation associated with metal on metal total hip replacement related heavy metal toxicity.