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Unusual presentation of the 'syndrome of the trephined'

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Author(s): Sujit Kumar G | Chacko Ari | Rajshekhar Vedantam

Journal: Neurology India
ISSN 0028-3886

Volume: 52;
Issue: 4;
Start page: 504;
Date: 2004;
Original page

Keywords: Craniectomy | cranioplasty | intracranial pressure

ABSTRACT
A 45-year-old lady underwent right fronto-parietal craniotomy and subtotal excision of a parasagittal meningioma. Bone flap was not replaced as it was infiltrated by the tumor. In the postoperative period she developed episodes of altered sensorium associated with worsening of left hemiparesis and a sunken scalp at the site of bone defect. Computed tomography (CT) of brain showed sunken scalp flap in the right fronto-parietal region with compression of the underlying brain. A diagnosis of syndrome of the trephined was considered and her symptoms improved with cranioplasty. Pathophysiology of the syndrome of the trephined is discussed.
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