Bilateral diploic hemorrhages - sickle cell crisis

Case contributed by Dr Andrew Kirby

Presentation

Known sickle cell anemia. New onset bilateral headache with no focal neurology.

Patient Data

Age: 14 years
Gender: Male

Normal brain parenchyma without evidence of ischemic or hemorrhagic stroke. There is perhaps slight widening of parietal diploe bilaterally and slight increase in density, but it is difficult to call this abnormal prospectively. A subsequent CT angiogram was normal.

One day later, the patient develops bilateral parietal swelling without trauma. Ultrasound demonstrates bilateral parietal subgaleal hematomas.

Parietal diploic signal is very abnormal and there are bilateral external subperiostela hematomas. These findings are consistent with sickle cell crisis and hemorrhage.

The brain and CSF spaces are normal.

Case Discussion

A very unusual case of sickle cell crisis presenting as headache and subsequently developing bilateral parietal subperiosteal hematomas.

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