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[Parkinsonism secondary to chronic subdural hematoma. A case report]

Masayuki Sugie1, Kenji Ishihara, Yuzou Horibe

  • 1Department of Neurology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.

No to Shinkei = Brain and Nerve
|November 8, 2006
PubMed

Insights

Secondary parkinsonism in an elderly man was linked to a chronic subdural hematoma (CSH). Prompt CT scans are crucial for diagnosing CSH-induced parkinsonism and guiding treatment.

Area of Science:

  • Neurology
  • Neurosurgery
  • Geriatrics

Background:

  • Secondary parkinsonism can mimic idiopathic Parkinson's disease, complicating diagnosis and treatment in elderly patients.
  • Chronic subdural hematoma (CSH) is a potential, yet often overlooked, cause of neurological deficits in older adults.

Observation:

  • An 83-year-old male presented with progressive memory impairment and gait disturbance, exacerbated by a recent fall.
  • Clinical examination revealed moderate cognitive impairment, characteristic parkinsonian gait, postural instability, akinesia, and right-sided rigidity without resting tremor.
  • CT imaging identified a right-sided CSH causing significant left hemisphere compression, corroborated by SPECT showing reduced left cerebral blood flow.

Findings:

  • The patient's parkinsonian symptoms and cognitive deficits showed gradual improvement with the resolution of the CSH.
  • This case demonstrates a direct correlation between CSH-induced mass effect and the development of secondary parkinsonism.

Implications:

  • Subacute progressive parkinsonism in the elderly warrants urgent CT evaluation to rule out CSH as a treatable cause.
  • Early diagnosis and management of CSH can potentially reverse or significantly improve neurological deficits, including parkinsonism.

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