Bi-Coronal Separated Skull Fracture: A Unique and Fatal Type of Traumatic Head Injury in Infancy: A Case Report
Korean Journal of Neurotrauma 2014³â 10±Ç 2È£ p.123 ~ p.125
ÀÌ°æ¹Î(Lee Kyung-Min) - Kyungpook National University School of Medicine Department of Neurosurgery
¹Ú±â¼ö(Park Ki-Su) - Kyungpook National University School of Medicine Department of Neurosurgery
¹Ú¼ºÇö(Park Seong-Hyun) - Kyungpook National University School of Medicine Department of Neurosurgery
Ȳ¼º±Ô(Hwang Sung-Kyoo) - Kyungpook National University School of Medicine Department of Neurosurgery
Abstract
The infantile skull is malleable, and its sutures are tightly adhering to the underlying dura and venous sinus. These characteristics, in association with the small amount of total blood volume, can result in a specific fatal type of skull fracture, which is unique to infancy. The authors report a case of this injury, and stress the need to pay attention to the possibility of massive bleeding during operation in infants. A 23-month-old female baby presented with semicomatose mentality after sustaining injuries by falling from a second-floor. Plain skull films showed bi-frontal skull fracture crossing the midline. Computed tomography revealed an acute subdural hematoma along the right convexity with severe brain edema. In the emergency operation, the scalp incision exposed massive bleeding from the fracture site. The bleeding was identified as arising from the lacerated and widely separated sagittal sinus beneath the fracture. The patient entered hypovolemic shock immediately after the scalp incision, and died from severe brain edema two days after the trauma and surgery. This case implies that special care should be paid during the operation of patients that have skull fracture overlying the venous sinus, especially when the fracture line is separated.
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Infant, Skull fractures, Sagittal sinus thrombosis, Brain injuries
KMID :
1143720140100020123
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