Supplementary Material for: Delayed intracerebral hemorrhage after DBS for Parkinson’s disease

Introduction: Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) is a well-established treatment for advanced Parkinson’s disease (PD), offering significant symptomatic relief. Although DBS is generally considered safe, it carries risks, including the potential for delayed complications such as intracerebral hemorrhage (ICH). Case Presentation: We present a rare case of a 67-year-old male with PD who developed delayed ICH after undergoing bilateral STN DBS. Initially, the patient showed no neurological deficits postoperatively, with imaging confirming correct lead placement and no signs of hemorrhage. However, on the second postoperative day, the patient developed sudden right-sided hemiparesis. A CT scan revealed ICH alongside the left lead. The hemorrhage was managed conservatively, and the patient underwent extensive physical therapy, leading to significant improvement. Over the next two weeks, the patient’s condition improved, and follow-up CT scans showed complete resolution of the ICH. At this point, the left lead stimulation was initiated, further improving the patient’s PD symptoms. This case illustrates the potential for delayed ICH following STN DBS, emphasizing the need for ongoing monitoring and individualized treatment strategies. Conclusion: This case underscores the importance of vigilant postoperative monitoring and individualized management strategies in STN DBS patients. Early detection and appropriate management of complications such as ICH are crucial for minimizing risks and ensuring optimal patient outcomes. The potential for delayed complications highlights the need for continuous follow-up, even in the absence of immediate postoperative issues.

引言：丘脑底核（subthalamic nucleus, STN）的深部脑刺激（Deep Brain Stimulation, DBS）是治疗晚期帕金森病（Parkinson’s disease, PD）的成熟手段，可显著缓解症状。尽管DBS通常被认为是安全的，但仍存在风险，包括发生颅内出血（intracerebral hemorrhage, ICH）等延迟性并发症的可能性。

病例报告：我们报告一例罕见病例，一名67岁男性PD患者在接受双侧STN DBS后发生延迟性ICH。术后初期，患者无神经功能缺损，影像学检查证实电极植入位置正确且无出血迹象。然而，术后第二天，患者突发右侧偏瘫。CT扫描显示左侧电极旁存在ICH。出血采用保守治疗，患者接受全面物理治疗后症状显著改善。接下来两周内，患者病情持续好转，随访CT扫描显示ICH完全吸收。此时启动左侧电极刺激，进一步改善了患者的PD症状。本病例表明STN DBS后可能发生延迟性ICH，强调了持续监测和个体化治疗策略的必要性。

结论：本病例强调了对接受STN DBS治疗的患者进行严密术后监测和个体化管理策略的重要性。早期发现并妥善处理ICH等并发症对于降低风险和确保患者最佳预后至关重要。即使术后无即时异常，延迟性并发症的潜在风险也凸显了持续随访的必要性。