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Severe skull deformity in a child with shunted hydrocephalus
Alireza Tabibkhooei1, Morteza Taheri2, Feyzollah Ebrahimniya3
1Department of Neurosurgery, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Insights
This case report details a rare instance of skull deformity in a child with shunted hydrocephalus, highlighting potential complications like chronic subdural hematomas. Early detection and treatment of hydrocephalus are crucial to prevent such outcomes.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Radiology
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain.
- Shunt placement is a common treatment for hydrocephalus in children.
- Complications, though rare, can arise from shunted hydrocephalus.
Observation:
- A 2.5-year-old boy with cerebral palsy, shunted hydrocephalus, and seizures presented with status epilepticus.
- Examination revealed skull deformity (brachycephaly).
- Imaging showed significant skull deformity and bilateral chronic subdural hematomas.
Findings:
- Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the skull deformity and subdural hematomas.
- The patient underwent craniotomy for hematoma evacuation.
- Despite initial neurological improvement, the patient's condition deteriorated due to co-existing medical issues.
Implications:
- Shunt-induced craniosynostosis, a rare complication, can lead to skull deformities like brachycephaly.
- Such deformities may be associated with macrocephaly and chronic subdural hematomas.
- This case underscores the importance of vigilant monitoring in children with shunted hydrocephalus, especially in cases of neglect or socioeconomic challenges.
Introduction:
We report a rare case of skull deformity in a child with shunted hydrocephalus.
Case Report:
A 2.5-year-old boy with a history of cerebral palsy (CP), shunted hydrocephalus and seizures was admitted to our children's hospital with status epilepticus. This was initially controlled with anesthesia. He referred to us intubated. Head examination found a skull deformity (brachycephaly). Head CT revealed a remarkable deformity and bilateral chronic subdural hematomas. MRI demonstrated voluminous extra-axial masses over the cerebral convexities with high signal on T1 and T2 sequences in favor of hematoma. The patient had a bilateral frontoparietal craniotomy and evacuation of subdural/epidural hematomas. Neurological status improved on the next day but because of co-existent medical problems, the patients gradually deteriorated and died.
Conclusion:
Shunt-induced craniosynostosis is rarely seen nowadays thanks to early detection and treatment of infantile hydrocephalus. But in the setting of child neglect or low socioeconomic culture, it can occur. Although it usually results in a skull deformity similar to the primary craniosynostosis such as scaphocephaly, brachycephaly, it can induce a macrocephalic skull and subsequently associated chronic haematomas.
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