Objective: The association of sinking flap syndrome with Parkinsonian tremors is very rare

Background: The association of sinking flap syndrome with Parkinsonian tremors is very rare

Method: We are reporting a rare complication of sinking flap syndrome following decompressive craniectomy. Patient had undergone Decompressive Craniectomy for traumatic contusion followed by autologous bone cranioplasty. Four years after cranioplasty, the patient had Parkinson’s tremors starting in right upper limbs and progressing to all 4 limbs. He was started on tablet syndopa, following which his tremors decreased transiently. Patient had undergone elevation of the sunken autologous bone flap, after which tremors disappeared. His symptoms recurred 6 months later. His bone flap was found to be sunken again on imaging studies and it was looking smaller than craniotomy defect due to bone resorption. MRI revealed distortion of basal ganglia without evidence of any parenchymal lesion.

Results: Redo cranioplasty with 3D printed patient specific titanium mesh implant was done. Patient’s symptoms recovered completely within 2 days after cranioplasty

Conclusion: Sinking flap syndrome is seen after decompressive craniectomy and is associated with wide range of symptoms mostly, headache, seizures, drowsiness, hemiparesis, sensory symptoms like hypoesthesia and proprioceptive deficit, Visual symptoms have also been reported. In our patient tremors are due to mechanical compression of cortico-basal ganglia-thalamocortical circuit by sunken flap which gets relieved after cranioplasty

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsonian-tremor-secondary-to-sinking-flap-syndrome-an-atypical-presentation/