Presentation
Middle aged male with previous A & E attendance. Swelling on right vertex. Claims he drilled into his head with a power drill.
Patient Data
Thin right sided subdural collection containing fluid and gas locules.
Sulcal effacement in the right cerebral hemisphere.
8mm uniform defect in the right frontal bone at the extreme vertex, which traverses both the outer and inner table of the skull.
Case Discussion
Remarkably the patient was telling the truth. He really did, without any analgesia, use a household electric power drill to drill through his skull (perhaps a DIY borehole?). He is believed to have a psychiatric illness.
The appearances suggest he used the 8mm drill-bit of the set. This has caused a subdural hematoma/collection with the introduction of a significant volume of air. The patient was transferred to a neurosurgical center for further management.
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