Repeated Cerebral Infarctions after Operation for Compound Depressed Skull Fracture: A Case Report

ABSTRACT

Open skull fracture with a dirty and depressed lesion can lead to post-traumatic complications such as an embolic or hemorrhagic infarction, although the incidence is very rare. We report on one unpredictable case of repeated embolic infarctions after reconstruction for a patient with an open depressed skull fracture. A 51-year-old man presented with open crush wound at the right frontal lesion with drowsy mentality because of falling down. Computed tomography (CT) showed a 4x5 cm sized, compound comminuted depressed fracture at the frontal lesion involving the frontal sinus. We performed emergent surgical reduction and reconstruction by primary repair and pericranial graft. Postoperative CT and magnetic resonance image showed multiple low-density lesions at the right frontal and temporal subcortical area confirmed as multiple acute infarctions. One month after the operation, the patient complained of sudden headache, and the CT showed low and high density lesions at the right temporal area. Trans-femoral cerebral angiography showed delayed venous flow around the right superior and middle parietal cortex. The patient received conservative treatment, and, three months after treatment, the patient had recovered to close to normal neurology.