Korean J Neurotrauma.  2014 Oct;10(2):123-125. 10.13004/kjnt.2014.10.2.123.

Bi-Coronal Separated Skull Fracture: A Unique and Fatal Type of Traumatic Head Injury in Infancy: A Case Report

• Lee K
• Park KS
• Park SH
• Hwang SK

• KMID: 2256245
• DOI: http://doi.org/10.13004/kjnt.2014.10.2.123

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.

Keyword

Infant; Skull fractures; Sagittal sinus thrombosis; Brain injuries

MeSH Terms

Blood Volume
Brain Edema
Brain Injuries
Craniocerebral Trauma*
Emergencies
Female
Hematoma, Subdural, Acute
Hemorrhage
Humans
Infant
Sagittal Sinus Thrombosis
Scalp
Shock
Skull
Skull Fractures*
Sutures

Figure

• 

  FIGURE 1 Plain skull radiographs showing diastatic fracture of the right coronal and sagittal sutures (A, B) and the fracture line extended to the left parietal area (C). The sutures were separated with small gaps between the bones.

• 

  FIGURE 2 Computed tomography scan showing a moderate amount of subdural hematoma on the right fronto-temporo-parietal lobe and moderate midline shifting (A, B).

• 

  FIGURE 3 Schematic drawing showing the tearing of the dura and venous sinus.

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