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.

Oculomotor disorder and diplopia cause a decline in quality of life and activities of daily living. The usefulness of orthoptic exercise for oculomotor disorder has been proven. However, there are few reports about orthoptic therapy with diplopia after a cerebrovascular accident in a convalescent rehabilitation ward which usually has no certified orthoptist. A previous study reported that diplopia caused by traumatic subarachnoid hemorrhage was improved after binocular gaze training. On the other hand, it was also reported that binocular training alone did not lead to complete recovery of diplopia, as no improvement was seen after the sixth day. We experienced a case of abducens nerve palsy and diplopia due to subarachnoid hemorrhage. Orthoptic treatment without special equipment restores disordered eye movement and improves double vision. Notably, binocular gazing training, devised to move the gazing target farther away or to the side, improved over a long period, unlike in a previous report. We report this case because it showed the availability of our attempted treatment for oculomotor disorder in a convalescent rehabilitation ward.