Rehabilitation Treatment for Paralysis Localized in the Hand Due to Syndrome of the Trephined

Syndrome of the trephined (SoT) is a complication that develops weeks to months after decompression craniotomy. Previous studies have reported cases in which paralysis, disturbance of consciousness, and cognitive impairment associated with the primary disease worsened, and cases in which new neurological symptoms appeared in addition to the primary disease. It is known that cranioplasty rapidly improves these symptoms, but there are few reports on rehabilitation treatment for SoT. In this report, we describe a case of paralysis limited to the right hand due to SoT. The patient was a 34-year-old male who underwent decompression craniotomy for a left acute subdural hematoma on day X-180. No paralysis or cognitive impairment were observed. He was discharged home on day X-106, but paralysis of the right hand appeared around day X-100. The cause was unknown, but it was suspected to be due to the decompression craniotomy. He received cranioplasty on day X, and was referred to the rehabilitation department on day X+1. We considered that the paralysis was influenced by SoT, and a task-oriented training and electrical stimulation therapy approach was applied. The paralysis improved rapidly and the patient recovered completely on day X+29. This case suggests that SoT resulting in paralysis limited to the fingers may have a good prognosis and that high goals can be set in rehabilitation treatment.