Severe skull deformity in a child with shunted hydrocephalus

We report a rare case of skull deformity in a child with shunted hydrocephalus.

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.

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.