Fukumura Masao, Murase Sho, Kuroda Yuzo, Nakazawa Kazutomo, Gon Yasufumi
Departments of Neurosurgery and.
Neurology, Kano General Hospital, Osaka, Japan.
J Neurosurg Case Lessons. 2021 Jun 14;1(24):CASE21216. doi: 10.3171/CASE21216.
Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurological and neurosurgical practice, but the presence of concomitant parkinsonism is extremely rare. Basal ganglia disturbance is a well-known underlying mechanism; however, few cases present with cerebral cortex compression as the cause of symptoms.
A 52-year-old man was referred to the authors' hospital with a 5-week history of gait disturbance and suspected Parkinson's disease. Neurological examination revealed a mask-like face, stooped posture, left-predominant rigidity, and postural instability. The authors initiated dopamine agonist administration, and brain magnetic resonance imaging (MRI) was scheduled. One week later, MRI showed bilateral CSDHs. The hematomas markedly compressed the bilateral cerebral cortex, whereas the midbrain and basal ganglia structures were intact. The patient underwent burr hole drainage and was discharged after 9 days without sequelae.
CSDH can cause parkinsonism by compressing the cerebral cortex, which is a part of the cortico-basal ganglia-thalamocortical circuit. Surgery leads to positive outcomes, as illustrated by this case, in which cerebral cortex compression caused parkinsonism.
慢性硬膜下血肿（CSDH）是神经科和神经外科临床常见病症，但合并帕金森症极为罕见。基底节功能障碍是一种已知的潜在机制；然而，很少有病例以大脑皮质受压作为症状的病因。
一名52岁男性因5周的步态障碍病史及疑似帕金森病被转诊至作者所在医院。神经科检查发现面具脸、弯腰驼背姿势、左侧为主的强直及姿势不稳。作者开始给予多巴胺激动剂治疗，并安排了脑部磁共振成像（MRI）检查。一周后，MRI显示双侧慢性硬膜下血肿。血肿明显压迫双侧大脑皮质，而中脑和基底节结构完整。患者接受了钻孔引流术，9天后出院，无后遗症。
慢性硬膜下血肿可通过压迫大脑皮质导致帕金森症，大脑皮质是皮质-基底节-丘脑皮质环路的一部分。如本病例所示，手术可带来积极结果，此例中大脑皮质受压导致了帕金森症。
