Walker Robert B, Grossen Audrey A, O'Neal Christen M, Conner Andrew K
J Neurosurg Case Lessons. 2022 Jul 18;4(3):CASE2262. doi: 10.3171/CASE2262.
Treatment options for Parkinson's disease (PD) include both medical and surgical approaches. Deep brain stimulation (DBS) is a surgical procedure that aims to improve motor symptomatology.
A 66-year-old White male with a 9-year history of PD presented to the neurosurgery clinic for DBS consideration. On the morning of scheduled surgery, preoperative laboratory test results revealed a prolonged prothrombin time of 50 seconds. Surgery was postponed, and further work-up revealed that the patient had a positive test result for lupus anticoagulant (LA). DBS implantation was performed 2 months later. The first stage of surgery was uneventful. The patient returned 1 week later for the second stage. Postoperatively, the patient exhibited a diminished level of consciousness. Computed tomography revealed left frontal intraparenchymal hemorrhage with surrounding edema, trace subarachnoid hemorrhage, intraventricular hemorrhage, and midline shift.
The authors suspect that the hemorrhage occurred secondary to venous infarct, because LA is associated with a paradoxically increased risk of thrombosis. Although there is no documented association between LA and acute or delayed hemorrhage, this case demonstrates a possible relationship in a patient following DBS placement. More research is needed to confirm an association with coexisting LA with PD and an increased hemorrhage risk in neurosurgical interventions.
帕金森病（PD）的治疗选择包括药物和手术方法。深部脑刺激（DBS）是一种旨在改善运动症状的外科手术。
一名66岁有9年帕金森病病史的白人男性到神经外科门诊考虑接受DBS治疗。在预定手术的早晨，术前实验室检查结果显示凝血酶原时间延长至50秒。手术推迟，进一步检查发现患者狼疮抗凝物（LA）检测结果呈阳性。2个月后进行了DBS植入手术。第一阶段手术顺利。患者1周后返回进行第二阶段手术。术后，患者意识水平下降。计算机断层扫描显示左额叶脑实质内出血伴周围水肿、微量蛛网膜下腔出血、脑室内出血和中线移位。
作者怀疑出血是静脉梗死继发的，因为LA与血栓形成风险反常增加有关。虽然没有文献记载LA与急性或延迟性出血之间的关联，但该病例显示了DBS植入术后患者中可能存在的关系。需要更多研究来证实LA与PD共存以及神经外科干预中出血风险增加之间的关联。
