Parkinson's syndrome after closed head injury: a single case report

A 36 year old man, who sustained a skull fracture in 1984, was unconscious for 24 hours, and developed signs of Parkinson's syndrome 6 weeks after the injury. When assessed in 1995, neuroimaging disclosed a cerebral infarctio n due to trauma involving the left caudate and lenticular nucleus. Parkinso n's syndrome was predominantly right sided, slowly progressive, and unrespo nsive to levodopa therapy. Reaction time tests showed slowness of movement initiation and execution with both hands, particularly the right. Recording of movement related cortical potentials suggested bilateral deficits in mo vement preparation. Neuropsychological assessment disclosed no evidence of major deficits on tests assessing executive function or working memory, wit h the exception of selective impairments on the Stroop and on a test of sel f ordered random number sequences. There was evidence of abulia. The result s are discussed in relation to previous literature on basal ganglia lesions and the effects of damage to different points of the frontostriatal circui ts.