Growing skull fracture
History of old trauma and surgical intervention for treatment of epidural hematoma. Bulging head swelling with progressive course since then.
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- Left parietal large calvarial defect.
- Left temporo-parietal area of encephalomalacia underlying the fracture, sequel of old cerebral contusion.
- The left temporo-parietal area of encephalomalacia and adjacent leptomeninges are protruding through the large bone defect.
- Right frontal area of encephalomalacia, sequel of old cerebral contusion (Counter-coup).
The exact pathogenesis remains unclear, but it is thought they occur secondary to skull fractures causing dural tears, allowing the leptomeninges and/or cerebral parenchyma to herniate into it. Pulsations from CSF erode the fracture margin, resulting in eventual expansion and non-union.