Weeks to years later, persisting scalp swelling invites further scrutiny after the cranial burst fracture has become a “growing skull fracture” with ongoing neurologic insult, enlarging calvarial and dural defects, and adherence of injured cortex to adjacent skull and overlying soft tissues (3–5).īecause prompt repair of burst fractures may prevent further brain dehiscence and ongoing neurologic injury, acute neuroimaging should delineate the injury: dural laceration and extrusion of cerebral cortex. When scalp swelling associated with cranial burst fracture is attributed to a simple skull fracture and overlying subgaleal hematoma, another condition sometimes accompanied by seizures, lethargy, respiratory failure, and hemorrhagic shock (2), the correct diagnosis is delayed. At the time of injury or shortly thereafter, these infants often present with seizures, contralateral hemiparesis, a Glasgow Coma Scale (GCS) score of 10 or less, and hemorrhagic shock (1). RESULTS: Surgery or autopsy confirmed MR findings (dural laceration and extracalvarial cerebral tissue) in all seven infants.ĬONCLUSION: MR imaging allows early diagnosis of skull fracture associated with acute cerebral extrusion.Ĭranial burst fracture, a severe head injury unique to infants, consists of a widely diastatic (> 4 mm) skull fracture associated with acute extracranial cerebral herniation beneath unbroken scalp. MR imaging was obtained after resuscitation and stabilization. METHODS: Seven infants aged 1 through 11 months who sustained cranial burst fractures, all initially imaged with skull radiography and CT, were studied or treated from 1992 through 1996. We sought to improve the early evaluation of infants believed to have sustained cranial burst fracture by including MR imaging, since this study clearly delineates the dural-cortical interface, the site of injury. Both conditions can also be associated with hemorrhagic shock. BACKGROUND AND PURPOSE: Scalp swelling associated with cranial burst fracture, a widely diastatic skull fracture of infants associated with dural laceration and acute cerebral extrusion, may be confused with that of a simple subgaleal hematoma.
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