Chudy Hana, Raguž Marina, Marčinković Petar, Rački Valentino, Papić Eliša, Hero Mario, Vuletić Vladimira, Chudy Darko
Department of Neurology, Dubrava University Hospital, Zagreb, Croatia.
Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.
Case Rep Neurol. 2025 May 6;17(1):62-71. doi: 10.1159/000546056. eCollection 2025 Jan-Dec.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established treatment for advanced Parkinson's disease (PD), offering significant symptomatic relief. Although DBS is generally considered safe, it carries risks, including the potential for delayed complications such as intracerebral hemorrhage (ICH).
We present a rare case of a 67-year-old male with PD who developed delayed ICH after undergoing bilateral STN DBS. Initially, the patient showed no neurological deficits postoperatively, with imaging confirming correct lead placement and no signs of hemorrhage. However, on the second postoperative day, the patient developed sudden right-sided hemiparesis. A CT scan revealed ICH alongside the left lead. The hemorrhage was managed conservatively, and the patient underwent extensive physical therapy, leading to significant improvement. Over the next 2 weeks, the patient's condition improved, and follow-up CT scans showed complete resolution of the ICH. At this point, the left lead stimulation was initiated, further improving the patient's PD symptoms. This case illustrates the potential for delayed ICH following STN DBS, emphasizing the need for ongoing monitoring and individualized treatment strategies.
This case underscores the importance of vigilant postoperative monitoring and individualized management strategies in STN DBS patients. Early detection and appropriate management of complications such as ICH are crucial for minimizing risks and ensuring optimal patient outcomes. The potential for delayed complications highlights the need for continuous follow-up, even in the absence of immediate postoperative issues.
丘脑底核（STN）的深部脑刺激（DBS）是一种成熟的晚期帕金森病（PD）治疗方法，能显著缓解症状。虽然DBS一般被认为是安全的，但它存在风险，包括脑出血（ICH）等延迟并发症的可能性。
我们报告一例罕见病例，一名67岁的帕金森病男性患者在接受双侧STN DBS后发生延迟性ICH。最初，患者术后无神经功能缺损，影像学检查证实电极植入正确且无出血迹象。然而，术后第二天，患者突然出现右侧偏瘫。CT扫描显示左侧电极旁有脑出血。出血采取保守治疗，患者接受了广泛的物理治疗，病情显著改善。在接下来的2周内，患者病情好转，后续CT扫描显示脑出血完全消退。此时，开始进行左侧电极刺激，进一步改善了患者的帕金森病症状。该病例说明了STN DBS后发生延迟性ICH的可能性，强调了持续监测和个体化治疗策略的必要性。
该病例强调了对STN DBS患者进行术后密切监测和个体化管理策略的重要性。早期发现并适当处理如ICH等并发症对于降低风险和确保患者获得最佳预后至关重要。延迟并发症的可能性凸显了即使术后无即刻问题也需持续随访的必要性。
