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Abstract
Introduction Growing skull fractures are rare complications of head injuries, and can present with neurological symptoms years after the initial insult. We discuss a case of an infant who presented with focal seizures after a seemingly innocuous head injury, and was subsequently found to have a growing skull fracture.
Case A previously well fourteen-month old girl presented with a 20 min left-sided focal seizures following a fall from standing height. There was no focal neurology post-ictally and observations remained within normal limits. On examination there was a large swelling in the right parietal region.
Head CT revealed an old skull fracture with herniation of the underlying cortex (Figures 1 and 2).
CT head showing 4 cm defect in right parietal region with herniation of the underlying cortex, covered by a thin, partially-calcified dura. Note focal area of encephalomalacia
Frontal and lateral 3D reconstruction of the CT head
Parents confirmed that the swelling was long-standing. There was a history of head trauma following a road traffic accident at 1 month of age, no imaging was done at the time of injury. Due to the nature of injury, the safeguarding protocol including a skeletal survey and ophthalmology review was initiated. This did not raise further concerns.
Our patient was started on carbamazepine and seizures have subsequently remained well controlled. She has since undergone surgical repair of the growing skull fracture via bicoronal approach and she has continued neurosurgical follow-up.
Discussion Growing skull fractures are rare (<1%) complications of paediatric skull fractures, and thought to occur when an underlying dural tear fails to heal properly. Enlargement is then caused by herniated brain, a leptomeningeal cyst, or dilated ventricles. Children <1 year old have a higher risk of complications from minor head trauma, and we recommend that they receive follow up, with further imaging considered if there are persistent concerns.