Presentation
Status post right hemicraniectomy for head trauma and intracranial hemorrhage 1 month ago. The patient now complains of imbalance. CT was made before reposition of the cranial bone flap.
Patient Data
Large right craniectomy with concavity of the overlying skin flap.
Right temporal subcortical area of low attenuation, likely sequel of prior cerebral insult.
Case Discussion
Sinking skin flap syndrome is a rare and potentially fatal complication of a decompressive craniectomy. It occurs when atmospheric pressure exceeds intracranial pressure at the craniectomy defect.
This results in displacement of the brain across various intracranial boundaries. This may result in subfalcine and/or transtentorial herniation.
Clinical findings may range from asymptomatic to a monosymptomatic state to an acute neurological deterioration. Radiological findings here are typical.