Medicina Fluminensis, Vol. 58 No. 2, 2022.
Case report, case study
https://doi.org/10.21860/medflum2022_275139
Deep brain stimulation and essential tremor in an elderly patient with brain atrophy: a case report
Klara Radović
orcid.org/0000-0001-9662-9046
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
Vladimira Vuletić
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska; Klinički bolnički centar Rijeka, Klinika za neurologiju, Rijeka, Hrvatska
Abstract
Aim: To report a case of a patient with drug-refractory essential tremor to whom deep brain stimulation led to successful tremor control and significantly improved quality of life despite old age, brain atrophy, perioperative and postoperative complications. Case report: A 72-year-old man came for the second opinion due to a long-term bilateral hand tremor, run as Parkinson’s disease, that prevented him in daily functioning. Physical and neurological examination revealed postural and action tremor, without bradykinesis or increased muscle tone. Magnetic resonance imaging of the brain showed brain atrophy, Dopamin Active Transfer scan and laboratory tests were normal. Diagnosis of essential tremor was set. During the period of two years, the patient took propranolol, clonazepam, primidone and topiramate which showed no effect. After detailed evaluation performed by a multidisciplinary team, bilateral deep brain stimulation of nucleus ventralis intermedius of thalamus was indicated. However, while contemplating the procedure throughout one year, the patient deteriorated cognitively. The condition was complicated by intraoperatively high blood pressure. The patient was postoperatively in a disturbed state with hallucinations, most likely caused by hypertensive encephalopathy. During the patients' stay in clinic, stimulation parameters were modified, and chronic drug therapy was determined. Despite indications that the outcomes of deep brain stimulation may not be good, the tremor is reduced, and the quality of the patients' life is significantly better. Conclusion: Thorough individual multidisciplinary evaluation is necessary when considering patients for deep brain stimulation. Careful perioperative and postoperative monitoring and adjustment of stimulations with proper medication may have a beneficial effect on the outcomes of deep brain stimulation in at-risk patients. Blood pressure should be strictly controlled during surgery as this can greatly complicate the condition.
Keywords
atrophy; deep brain stimulation; dementia; essential tremor; thalamus
Hrčak ID:
275139
URI
Publication date:
1.6.2022.
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