Anwari Colis, Raghavan Nila, Rao B C, Prasad Ramakrishna
Chief Physiotherapist, PCMH Restore Health Bangalore, Karnataka, India.
Mount Carmel College, Bengaluru, Karnataka, India.
J Family Med Prim Care. 2024 Apr;13(4):1550-1554. doi: 10.4103/jfmpc.jfmpc_886_23. Epub 2024 Apr 22.
Chronic subdural hematoma (CSDH) is a great mimicker. It should be considered in anyone presenting with chronic headaches that show postural variation. Parkinsonism following CSDH, while known, is only rarely reported in the literature. Hyponatremia, rapid correction of hyponatremia, medications, and mechanical pressure are thought to be risk factors. Here, we report a case of a 61-year-old male diagnosed with bilateral CSDH managed by craniotomy and clot evacuation who developed parkinsonism. We share several learnings (clinical pearls) that emerged from the close collaboration and co-learning curve between a family physician and physiotherapist involved in home-based rehabilitation. In conclusion, while managing the postoperative course of patients with CSDH, clinicians should maintain a high index of suspicion for parkinsonism. Early recognition and appropriate management with syndopa with supportive physiotherapy results in significant improvement of function and quality of life. Notably, parkinsonism following SDH is transient and nonprogressive and may not require lifelong therapy.
慢性硬膜下血肿(CSDH)极具迷惑性。任何出现体位改变性慢性头痛的患者都应考虑到该病。虽然已知CSDH后会出现帕金森综合征,但文献中对此报道极少。低钠血症、低钠血症的快速纠正、药物及机械压迫被认为是危险因素。在此,我们报告一例61岁男性患者,其被诊断为双侧CSDH,接受开颅血肿清除术治疗后出现了帕金森综合征。我们分享了参与居家康复的家庭医生和物理治疗师之间密切合作及共同学习过程中获得的一些经验(临床要点)。总之,在管理CSDH患者的术后过程中,临床医生应高度怀疑帕金森综合征。早期识别并使用左旋多巴联合支持性物理治疗进行适当管理,可显著改善功能和生活质量。值得注意的是,SDH后出现的帕金森综合征是短暂且非进行性的,可能不需要终身治疗。