1
|
Rojvirat C, Arismendi GR, Feinstein E, Guzman M, Citron BA, Delic V. Systematic Review of Post-Traumatic Parkinsonism, an Emerging Parkinsonian Disorder Among Survivors of Traumatic Brain Injury. Neurotrauma Rep 2024; 5:37-49. [PMID: 38292732 PMCID: PMC10825274 DOI: 10.1089/neur.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
This systematic review focuses on an increasing subset of traumatic brain injury (TBI) survivors who develop post-traumatic parkinsonism (PTP), characterized by slowness of movement (bradykinesia), rigidity (stiffness), postural instability, and resting tremors caused by obstruction or damage to deep brain structures of the basal ganglia. PTP is rare, and one hypothesis to explain PTP rarity is that TBIs severe enough to affect deep brain structures are often lethal; however, with increasing survivability of TBIs, these numbers are expected to increase. The goal of this review is to raise awareness of an expected global increase of a subgroup of TBI patients who are treatment responsive and report therapeutic results aiding providers in diagnosing, educating, and treating PTP patients. Literature over the past 100 years was considered, and 44,663 peer-reviewed articles were identified. Inclusion criteria required a clinical indication of parkinsonian signs and TBI. Twenty-six case reports were ultimately included from which 36 individual patient data points were extracted for this review. Between 1980 and 2010, there has been an increase in reporting of PTP decade after decade. Forty-seven percent of PTP cases have 1-6 months of latency to symptom onset, and 83% of cases were male. PTP can occur with or without presence of brain lesions, and the most common type of injuries that cause PTP are motor vehicle accidents followed by falls. PTP patients are responsive to surgery or medication treatments. Further detail on PTP symptomology, treatment responsiveness, and injury types is provided.
Collapse
Affiliation(s)
- Catherine Rojvirat
- Laboratory of Molecular Biology, VA New Jersey Health Care System, East Orange, New Jersey, USA
- Department of Neurology, VA New Jersey Health Care System, East Orange, New Jersey, USA
- Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gabriel R. Arismendi
- Laboratory of Molecular Biology, VA New Jersey Health Care System, East Orange, New Jersey, USA
- Department of Neurology, VA New Jersey Health Care System, East Orange, New Jersey, USA
- Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Erin Feinstein
- Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Maynard Guzman
- Laboratory of Molecular Biology, VA New Jersey Health Care System, East Orange, New Jersey, USA
| | - Bruce A. Citron
- Laboratory of Molecular Biology, VA New Jersey Health Care System, East Orange, New Jersey, USA
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vedad Delic
- Laboratory of Molecular Biology, VA New Jersey Health Care System, East Orange, New Jersey, USA
- Department of Pharmacology, Physiology, and Neuroscience, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
2
|
Cheng PW, Tsai RA, Lee CH, Chen WC. Chronic subdural haematoma mimicking extrapyramidal symptoms. BMJ Case Rep 2023; 16:e255286. [PMID: 38050397 PMCID: PMC10693859 DOI: 10.1136/bcr-2023-255286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
A male patient in his 70s with chronic schizophrenia, who could previously walk independently, developed a gait disturbance without any significant neurological deficit. Initially, his short step length and unstable gait were thought to be related to extrapyramidal symptoms caused by medication side effects. We tapered his antipsychotic medication, but the unstable gait persisted. After 2 weeks of observation, we noted general weakness with left-side dominance, leading us to consider a focal brain lesion despite there being no recent history of falling or trauma. A CT scan of the brain showed chronic subdural haematoma and the patient underwent emergency surgery. After 14 days of treatment, he was discharged back to the chronic ward.
Collapse
Affiliation(s)
- Po Wen Cheng
- General Psychiatry Department, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
| | - Ruei An Tsai
- General Psychiatry Department, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
| | - Chien-Hui Lee
- Department of Neurosurgery, Buddhist Tzu-Chi General Hospital and Tzu-Chi University, Hualien, Taiwan
| | - Wen-Ching Chen
- General Psychiatry Department, Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
| |
Collapse
|
3
|
Fahmi A, Kustono H, Adhistira KS, Subianto H, Utomo B, Turchan A. Chronic subdural hematoma-induced parkinsonism: A systematic review. Clin Neurol Neurosurg 2021; 208:106826. [PMID: 34314946 DOI: 10.1016/j.clineuro.2021.106826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 06/29/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is one of the most common neurosurgical cases, especially in elderly individuals. Secondary parkinsonism due to CSDH is a rare entity. The mechanism of parkinsonism symptoms in chronic subdural hematoma has been suggested to include direct mechanical compression of the basal ganglia due to hematoma or indirectly through brain structure changes due to space lesions and vascular disorders. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. OBJECTIVES To systematically review the literature on CSDH-induced parkinsonism. SEARCH METHODS This is a systematic review on case reports. Literature search was performed using the predefined keywords on PubMed, ProQuest, and Google Scholar. We also provided our own case report and compared it with published studies. RESULT Sixteen cases from 13 case reports/series were identified, predominantly consisting of male patients with the mean age of 66.5 ± 9.73 years. The most common symptoms were rigidity, gait disturbance, and bradykinesia, observed in 12 (75%) cases each. The second and third most common symptoms were tremor (11; 68.75%) and facial masking (8; 50%), respectively. Other reported symptoms were dysphasia (3; 18.75%), dysarthria (3; 18.75%), and urinary incontinence (2; 12. 5%). Time gap between the symptom onset and CSDH diagnosis and unilateral location seemed to influence the outcome. CONCLUSION Only 16 CSDH-induced parkinsonism were identified since the 1960s. This condition is thought to occur due to basal ganglia compression. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. Timely CSDH diagnosis might yield better outcome. However, further research on CSDH-induced parkinsonism is needed, especially in the mechanisms and treatment outcomes.
Collapse
Affiliation(s)
- Achmad Fahmi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Heru Kustono
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Komang Sena Adhistira
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Heri Subianto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Utomo
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
4
|
Wijamunige ES, Dharmawardene VI. Chronic subdural hematoma presenting as reversible Parkinson-like symptoms and bladder and bowel dysfunction in a patient with schizophrenia. Indian J Psychiatry 2021; 63:110-112. [PMID: 34083836 PMCID: PMC8106420 DOI: 10.4103/psychiatry.indianjpsychiatry_209_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/29/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022] Open
|