Sinking Skin Flap Syndrome/Syndrome of trephinad

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Sinking Skin Flap Syndrome/Sydrome of trephinad

  • History of previous cranioectomy.
  • Pathophysiology:
    – forces of atmospheric pressure and gravity overwhelm intracranial pressure causing herniation of brain
    – CSF hypovolemia and reduction of cerebral blood flow
    – Orthostatic positioning has been described to exacerbate the condition.
  • Symptoms
    – Non specific neurologic symptoms eg dizziness, memory loss, tinnitus
    – Psychiatric symptoms
    – Focal deficits, autonomic symptoms
  • Dx: CT scan is typical (prior craniectomy with mass effect)
  • Treatment: early cranioplasty results in normalization of the underlying pressure imbalance and recovery of neurologic function.

Reference:

Flávio Ramalho Romero et al. Sinking skin flap syndrome with delayed dysautonomic syndrome—An atypical presentation. International Journal of Surgery Case Reports 4 (2013) 1007–1009

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