Objective: In this case report, we describe the development of hemidystonia due to hemorrhagic complication after subthalamic deep brain stimulation (STN-DBS) in a patient with Parkinson’s disease (PD). To our knowledge, this surgical complication has never been reported.

Background: Intraoperative bleeding is a possibile complication of DBS, sometimes leading to chronic disability.

Methods: A 59-year-old woman with PD developed a left hemiparesis immediately after STN-DBS, due to right midbrain hemorrhage (Figure 1). In addition to pyramidal signs, we observed a complete resolution of left limbs rigidity due to a lesional effect, while the right parkinsonian signs improved with unilateral left STN-DBS.

Results: After a 2-months intensive rehabilitation, left hemiparesis greatly improved, without the recurrence of parkinsonian signs. Unfortunately, the patient progressively developed a left hemidystonia, not responsive either to right STN-DBS and to oral therapy. Therefore, hemidystonia was treated with botulinum toxin injections, with a complete resolution on upper limb and partial responsiveness on lower limb.

Conclusions: Hemorrhage is probably the most severe complication of DBS, with an incidence of about 5% (1). The most frequent sequelae are changes in consciousness, hemiparesis and visual loss. Secondary dystonia has been described in a few cases after midbrain hemorrhage but, to our knowledge, it has never been reported as STN-DBS complication (2). In our case, the combination of unilateral STN-DBS and botulinum toxin treatment lead to a quite good control of either parkinsonian and dystonic features.

References: 1) Zrinzo L, et al. Reducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review. J Neurosurg 2012;116:84-94. 2) Muñoz EJ, et al. Upper-limb dystonia secondary to a midbrain hemorrhage. Mov Disord 1996;11:96-99.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hemidystonia-due-to-midbrain-hemorrhage-an-unusal-complication-of-deep-brain-stimulation/