Intracranial hypertension with expansion of subarachnoid space subsequent to isolated linear fracture in an infant: A case report

Abstract

Linear skull fractures without intracranial injuries in children usually resolve without complications, and rarely cause intracranial hypertension or hydrocephalus. We present a case of intracranial hypertension with expansion of the subarachnoid space subsequent to a linear skull fracture. A 15-month-old girl developed vomiting and irritability 28 days after an occipital linear skull fracture due to an accidental fall. It was not possible to give an accurate diagnosis despite her frequent emergency room visits. On day 40 after the injury, a follow-up head computed tomography scan after the skull fracture showed dilatation of the cerebral sulci and cranial sutures, while fundoscopy showed bilateral papilledema. She was hospitalized because of suspected intracranial hypertension. Head magnetic resonance imaging showed flattening of the posterior sclera, distension of the perioptic subarachnoid space, and an empty sella with a flattened pituitary gland. She was diagnosed with intracranial hypertension and received an Ommaya reservoir. On day 62 after the injury, she was discharged with symptomatic improvement. Head trauma, including that caused by linear skull fractures without intracranial injuries, causes intracranial hypertension or hydrocephalus in children. Thus, prolonged atypical symptoms such as vomiting or irritability after head trauma necessitate consideration of additional examinations including head computed tomography.