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A 15 year old boy, who had undergone ventriculo-peritoneal (VP) shunting for hydrocephalus at age 5, presented with a several-month history of progressive right hemiparesis, headache, and urinary incontinence for 3 weeks. Clinical examination revealed grade 3 power (MRC classification) in the right limbs. Cranial computed tomography (CT) showed a high density mass with surface calcification (fig 1A–D).
Preoperatively it was considered he had a chronic, calcified subdural haematoma from VP shunt overdrainage. The mass was removed via craniotomy and confirmed organised subdural blood clot, which was thickly calcified on its surface. Seven days post operation, CT revealed that the haematoma had been totally resected, the brain had expanded, and the lateral ventricles were large (fig 2A–D).
One month later his preoperative motor symptoms had resolved. Over the next year his mental status improved and he became capable of all activities of daily living despite persistent hydrocephalus on serial CT scans. He was considered to have compensated chronic hydrocephalus.
Calcification of chronic subdural haematomas, which are caused by over drainage of cerebrospinal fluid (CSF) by shunting,1 is not common. Several reported cases have been asymptomatic,2 implying that CSF is shunted enough to maintain normal intracranial pressure. Bilateral calcified subdural haematomas—“armoured brain”—can, however, result in severe symptoms.3–5 Excision of the haematoma can—as in this patient—lead to good outcome.
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