A Rare Case of Akathisia After Removal of Subdural Hematoma During Treatment for Malignant Pleural Mesothelioma: Akathisia Induced by Brain Injury or Immune Checkpoint Inhibition.

Akathisia is a movement disorder primarily caused by antipsychotic medications. Although extremely rare, cases caused by immune checkpoint inhibitors or traumatic brain injury have also been reported. We report on the case of an 82-year-old patient with malignant pleural mesothelioma who developed akathisia following subdural hematoma removal and achieved successful symptom control. Three months after receiving nivolumab and ipilimumab, the patient developed incomplete paralysis of the right side of the body. Examination and medical history revealed that a subdural hematoma was the cause of the movement abnormality. Following hematoma removal, the patient became unable to sit still. We suspected the condition as akathisia secondary to traumatic brain injury. Anticholinergic medication successfully controlled the symptoms, allowing treatment for mesothelioma to resume. Neurological immune-related adverse events associated with immune checkpoint inhibitors are often difficult to resolve completely and can lead to discontinuation of cancer treatment. We hope this case report underscores the importance of carefully evaluating the pathophysiology of neurological abnormalities arising during cancer treatment.