The indications for cranioplasty after decompressive craniectomy are generally cosmetic repair and restoration of brain protection. However, in selected cases, neurological deterioration can be reversed by cranioplasty. A 38-year-old man presented with subdural empyema and diffusebrain swelling. He underwent decompressive craniectomy. Two months later, he discharged with mild motor weakness of contralateral limbs. Left hemiparesis was more aggravated during follow-up period. Furthermore, gate disturbance, resting tremor, rigidity and bradykinesia, the most representative parkinsonian symptoms, were developed. Not only levodopa didn't improve the above symptoms but also paradoxical brain swelling was confirmed by brain magnetic resonance image (MRI), which was relieved much by cranioplasty. We report a case, the syndrome of the trephined occurred by intracranial hypotension, which was misunderstood as secondary parkinsonism and was able to be treated successfully by cranioplasty.