An extreme syndrome of the trephined following decompressive craniectomy is reported. The most extensive clinical syndrome observed installed over four weeks and consisted of bradypsychia, dysartria, limb rigidity with equine varus feets predominating on the right. The syndrome was aggravated when the patient was sitting with the sequential appereance over minutes of a typical parkinsonian levodopa resistant tremor starting on the right side, extending to the four limbs, followed with diplopia resulting from a left abducens nerve palsy followed by a left sided mydriasis. All the signs would recover within 1 hour or two after horizontalisation. It was correlated with an orthostatic progressive sinking of the skin flap, MRI and CT-Scan mesodiencephalic distortion without evidence of parenchymal lesion. Brain stem auditory evoked potential wave III latency increase, were observed on the right side upon verticalisation of the patient. EEG exploration excluded any epileptic activity. Symptoms were fully recovered within 2 days after cranioplasty was performed. The cranioplasty had to be removed twice due to infection. Bradypsychia, speech fluency, limb rigidity and tremor reappeared within the week after removal of the prosthesis. While waiting for sterilisation of the operative site, the symptoms could be successfully prevented by a custom-made transparent suction-cup helmet before completion of cranioplasty.
- brain stem auditory evoked potential
- decompressive craniectomy
- parkinson syndrome
- trephined syndrome