Katy Harvey, BMBCh,
Martin R. Turner, PhD, MRCP and
Jane Adcock, MD, FRACP
From Oxford University Medical School (K.H.); Department of Neurology (M.R.T., J.A.), John Radcliffe Hospital; and Oxford University Department of Clinical Neurology (M.R.T.), Oxford, UK.
Address correspondence and reprint requests to Dr. Martin Turner, Department of Clinical Neurology, West Wing Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK martin.turner{at}clneuro.ox.ac.uk
An 18-year-old woman had a partial seizure affecting the leftarm with secondary generalization. There was no history of seizures.Her mother recalled that the patient sustained a head injuryas a 3-week-old neonate, falling from the sofa onto a carpetedfloor. No investigations were undertaken at the time of thefall, but a CT scan postseizure revealed a skull defect of theright parietal bone, with underlying gliosis (figure).
Figure CT and MR images of the patient’s growing fracture
CT of the brain revealed a skull defect on the localizing sagittal image (A), with axial views demonstrating underlying gliosis and demarcated volume loss within the lateral right sensorimotor cortex (B). The cerebral volume loss and bony defect are both striking on the subsequent axial T2-weighted (C) and coronal fluid-attenuated inversion recovery (D) MRI sequences.
Growing fractures progressively increase in size and may beassociated with an underlying dural tear and arachnoid cystformation. They are estimated to occur in <1% of linear skullfractures sustained under 3 years of age—the most vulnerableage group.1 They can present many years later with headache,seizures, and hemiparesis.2
Vignes JR, Jeelani NU, Jeelani A, Dautheribes M, Liguoro D. Growing skull fracture after minor closed-head injury. J Pediatr 2007;151:316–318.[Medline]
Kutlay M, Demircan N, Akin ON, Basekim C. Untreated growing cranial fractures detected in late stage. Neurosurgery 1998;43:72–76; discussion 76–77.[Medline]
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