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Case report.
A man aged 27 years fell backward down stairs, striking his head and losing consciousness. In the emergency department, he had a Glasgow Coma Score of 3, and his pupils were fixed and dilated. There was no significant hypoxia after the injury. CT showed left parieto-occipital fracture and underlying subdural hematoma with minimal midline shift. He underwent left hemicraniectomy and evacuation of subdural and epidural hematoma and required 2 weeks of postoperative respiratory support in an intensive care unit. As he regained voluntary movement, he had persistent slowing of left-sided movements and left hand tremor in the following months. Cerebral MRI 9 months after the injury confirmed left frontoparietal post-traumatic change and a lesion in the right cerebral peduncle involving the midbrain and region of the right substantia nigra (figure). One year after the injury, he had decreased left arm swing with walking, asymmetric facial hypomimia, marked rigidity of the left arm and leg, but no significant pyramidal signs. He could …
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