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. 2013;4(11):1007-9.
doi: 10.1016/j.ijscr.2013.08.013. Epub 2013 Sep 8.

Sinking skin flap syndrome with delayed dysautonomic syndrome-An atypical presentation

Flávio Ramalho Romero  1 , Marco Antônio Zanini, Luis Gustavo Ducati, Roberto Colichio Gabarra
Affiliations

Sinking skin flap syndrome with delayed dysautonomic syndrome-An atypical presentation

Flávio Ramalho Romero et al. Int J Surg Case Rep. 2013.

Abstract

Introduction: Sinking skin flap syndrome or "syndrome of the trephined" is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures.

Presentation of case: We report a case of 21 years old man with trefinated syndrome showing delayed dysautonomic changes.

Discussion: Our patient had a large bone flap defect and a VP shunt that constitute risk factors to develop this syndrome. Also, there is reabsorption of bone tissue while it is placed in subcutaneous tissue. The principal symptoms of sinking skin flap syndrome are severe headache, mental changes, focal deficits, or seizures. Our patient presented with a delayed dysautonomic syndrome, with signs and symptoms very characteristics. Only few cases of this syndrome were related in literature and none were presented with dysautonomic syndrome.

Conclusion: We reported here a very uncommon case of sinking skill flap syndrome that causes a severe dysautonomic syndrome and worsening the patient condition.

Keywords: Dysautonomic syndrome; Sinking skin flap syndrome; Trefinated.

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Figures

Fig. 1
Fig. 1
CT scan on admission showing extensive acute left subdural hematoma.
Fig. 2
Fig. 2
Patients CT scan exam after worsening in neurological condition.
Fig. 3
Fig. 3
Patient after worsening in his neurological condition, before revision of VP system.
See this image and copyright information in PMC

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