This adult male had significant brain injury/multicompartmental intracranial hemorrhage (not shown), after a road traffic accident. During the admission, the patient developed high intracranial pressure which failed to respond to the ICP lowering agents. Then bilateral frontal craniectomies were performed and a ventriculoperitoneal (VP) shunt was inserted.

Much later the patient developed severe headaches and dizziness. CT performed (this study) showed signs of sinking skin flap syndrome. This occurs due to atmospheric pressure being higher than intracranial pressure.

Although it is an uncommon postoperative complication it needs to be considered in the proper clinical context, keeping in mind most concave craniotomies are symptomatic.