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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 5  |  Page : 556-558

Spontaneous rupture of hydrocephalic head


Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Date of Submission30-Aug-2013
Date of Decision31-Aug-2013
Date of Acceptance20-Oct-2013
Date of Web Publication22-Nov-2013

Correspondence Address:
Hitesh Kumar Gurjar
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.121955

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How to cite this article:
Garg K, Gurjar HK, Singh PK, Satyarthee GD, Singh M, Chandra P S, Sharma BS. Spontaneous rupture of hydrocephalic head. Neurol India 2013;61:556-8

How to cite this URL:
Garg K, Gurjar HK, Singh PK, Satyarthee GD, Singh M, Chandra P S, Sharma BS. Spontaneous rupture of hydrocephalic head. Neurol India [serial online] 2013 [cited 2022 May 21];61:556-8. Available from: https://www.neurologyindia.com/text.asp?2013/61/5/556/121955


Sir,

A 6-month-old female child, a product of non-consanguineous marriage, and born at full term by normal vaginal delivery, presented to us with a large head and a swelling over the lower back region since birth. She was diagnosed to have hydrocephalous in the antenatal period at 8 months of gestation, but termination of pregnancy could not be done. She was born with a large head and the head size kept on increasing gradually. She also had weakness in both lower limbs (power 0/5). She was diagnosed to have meningomyelocele (MMC) and congenital hydrocephalous and was advised repair of MMC and ventriculoperitoneal shunt. Parents did not give consent for surgery and the child was taken back home. While at home, she developed dehiscence of the skin over the vertex with cerebrospinal fluid (CSF) leakage from it without any form of preceding trauma. [Figure 1]a, b and [Figure 2]. There was big skin defect over the vertex when she was brought to emergency department. She was running fever and her total leucocyte count was raised. Non-contrast computed tomography head revealed bilateral large subdural hematoma with pneumocephalous and pneumoventricle. The brain tissue was protruding out through the ruptured skin [Figure 3].
Figure 1: (a) Clinical photograph of the patient showing large head size (as compared to body) with sunken anterior fontanelle and downward deviation of eyeballs, (b) Superior view of vertex showing sunken anterior fontanelle with large skin defect in left posterior quadrant, (c) Enlarged view of skin defect with the exposed brain tissue (white arrow)

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Figure 2: Magnetic resonance imaging (MRI) head T1-WI and T2-WI axial images showing hydrocephalous with extremely thin cortical mantle (a and b), MRI whole spine T1-WI and T2-WI sagittal section showing extremely thin spinal cord with extension of thecal sac into the lumbar region swelling

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Figure 3: Non-contrast computed tomography head following rupture of the head showing biltaeral subdural with pneumoventricle and pneumocephalous with air fluid level

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Despite the widespread awareness and availability of neurosurgical services these days, few cases of hydrocephalous still remain untreated. Spontaneous rupture of hydrocephalous is an odd phenomenon. Long standing tension hydrocephalus can occasionally lead to formation of ventricular diverticula [1] or ventricular rupture. It can rupture into the cisterns leading to spontaneous ventriculostomy [2] or it can rupture through the skin leading to "Spontaneous brain rupture". Spontaneous brain rupture might only appear in infantile hydrocephalus if the sutures are not closed and the skull is able to expand.

Ventriculomegaly in infants, whose cranial sutures have not closed, is manifested by enlargement of the head size due to separation of the sutures. However, ventricular enlargement occurs at the expense of the thinning cerebral mantle. There is also associated thinning of the skin and the subcutaneous tissues. Due to the weight of the head and problems with its positioning, skin atrophy or even ulcers and local infection might also occur. This could be the principal external mechanical factor, which causes weakening of the skin and promotes CSF leakage in cases of untreated ventricular distension in infants. A combination of internal biomechanical forces as a result of ventricular expansion and external mechanical irritation due to trauma to thinned skin leads to spontaneous rupture of brain.

 
  References Top

1.Garg K, Mahapatra AK. A rare case of ventricular diverticulum in a child with occipital encephalocele. Pediatr Neurosurg 2012;48:26-9.  Back to cited text no. 1
[PUBMED]    
2.Mahapatra AK. Spontaneous ventriculocisternostomy. Indian J Pediatr 1985;52:93-5.  Back to cited text no. 2
[PUBMED]    


    Figures

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This article has been cited by
1 Spontaneous external rupture of hydrocephalus after fontanelle closure: a case report and review of literature
Varidh Katiyar, Kanwaljeet Garg, Ramesh Doddamani, Pankaj Kumar Singh, Manmohan Singh, P. Sarat Chandra
Child's Nervous System. 2021; 37(6): 2069
[Pubmed] | [DOI]



 

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