Chronic subdural hematoma-induced parkinsonism: A systematic review

• Published in: Clinical neurology and neurosurgery 2021-09, Vol.208, p.106826-106826, Article 106826
• Main Authors: Fahmi, Achmad, Kustono, Heru, Adhistira, Komang Sena, Subianto, Heri, Utomo, Budi, Turchan, Agus
• Format: Article
• Language: English
• Subjects: Aged; Asymptomatic; Basal ganglia; Basal Ganglia - pathology; Blood; Brain; Brain diseases; Case reports; Central nervous system diseases; Chronic subdural hematoma; Compression; Data collection; Diagnosis; Dura mater; Female; Gait; Head injuries; Hematoma; Hematoma, Subdural, Chronic - complications; Hematoma, Subdural, Chronic - pathology; Humans; Magnetic resonance imaging; Male; Meninges; Middle Aged; Movement disorders; Neurological disorders; Neurology; Neurosurgery; Parkinson's disease; Parkinsonian Disorders - etiology; Parkinsonian Disorders - pathology; Parkinsonism; Surgery; Systematic review; Trauma; Tremor; Urinary incontinence
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.106826

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. To systematically review the literature on CSDH-induced parkinsonism. 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. 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. 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. •Parkinsonism is a rare effect of chronic subdural hematoma.•Parkinsonism is thought to occur due to basal ganglia compression.•Further research is encouraged to learn more the mechanism of chronic subdural hematoma induced parkinsonism.