Reversible hemi-parkinsonism syndrome secondary to bilateral subdural hematomas: case report and literature review

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Introduction: Chronic subdural hematoma (CSDH) is a rare but reversible cause of secondary parkinsonism. Bilateral CSDH presenting with unilateral parkinsonian features is exceptionally uncommon. Case presentation: A 61-year-old male from Comoros developed a right-hand tremor, intermittent dystonia, and mild right-sided motor deficits months after a motor vehicle accident. Medical therapy was ineffective. Imaging revealed bilateral frontoparietal subdural collections with a right hematoma causing a midline shift. Bilateral burr-hole evacuation led to marked improvement, with the UPDRS Part III score improving from approximately 7 to 1–2 points and near-complete hematoma resolution on follow-up. Discussion: This case demonstrates the variable presentation of CSDH-induced parkinsonism, as unilateral motor symptoms occurred despite bilateral hematomas. It underscores the importance of thorough neurological assessment, UPDRS monitoring, and prompt neuroimaging. Conclusion: This is one of the first reported cases globally of bilateral CSDH causing unilateral parkinsonism, highlighting the potential for full neurological recovery with timely surgical intervention and the avoidance of unnecessary long-term pharmacological treatment.