SUDDEN ONSET OF PARKINSON’S DISEASE AFTER TRAUMATIC BRAIN INJURY – AN UNUSUAL CAUSE OF DIFFICULT WEANING

Cristian Cobilinschi; Cristina Nicolăescu; Angela Popa; Florin Scărlătescu; Ioana Marina Grințescu

doi:10.33695/rojes.v3i1.40

Cristian Cobilinschi 1Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Bucharest, Romania 2Department of Anaesthesiology and Intensive Care – II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Cristina Nicolăescu 1Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Bucharest, Romania
Angela Popa 1Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Bucharest, Romania
Florin Scărlătescu 3Department of Neurology, Bucharest Clinical Emergency Hospital, Bucharest, Romania
Ioana Marina Grințescu 1Department of Anaesthesiology and Intensive Care, Bucharest Clinical Emergency Hospital, Bucharest, Romania 3Department of Neurology, Bucharest Clinical Emergency Hospital, Bucharest, Romania

DOI: https://doi.org/10.33695/rojes.v3i1.40

Keywords: traumatic brain injury, Parkinson’s disease, weaning criteria, intensive care, levo-dopa

Abstract

History of trauma brain injury (TBI) is associated with an increased risk of developing Parkinson’s disease (PD), considering that dopaminergic neuronal system is especially vulnerable to injury due to its localization. The onset of PD is considered to be rather late in patients with severe TBI and related to the development of chronic neuroinflammation. Relatively few data are available regarding sudden PD diagnosis after severe TBI. We present the case of a 76-year-old male patient admitted to our unit with multiple trauma after a car accident. He was found with a Glasgow Coma Scale of 7 and required intubation at the scene of the accident. The patient had previously no history of neurological disease. On admission he was continuously sedated, mechanically ventilated, and hemodynamic unstable. Supportive therapy was initiated, and 72 hours later neurologic evaluation revealed bilateral resistance to passive movement and intermittent tremor involving both upper and lower limbs. Neurological examination confirmed specific symptomatology for Parkinson’s and levodopa administration was initiated three times daily. After 24 hours, neurologic symptoms faded and the patient was successfully extubated. Neurologic re-evaluation after ICU discharge confirmed PD diagnostic. From our knowledge this is one of a few reports available about sudden PD onset after severe TBI. Although the history of the patient revealed no signs of any neurological deficit therapeutic test with levodopa facilitated a secure extubation.

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