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TRAUMATIC SKULL PAN-SUTURAL DIASTASIS

Rajashri P Kale, SP Kale
*Senior House Officer-Accident and Emergency, City Hospital NHS Trust Dudley Road, Birmingham, B18 7QH. **Specialist Registrar in Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire, SY 10 7 AQ.

A 65 year old patient presented with headache following trivial fall. The clinical as well as neurological examinations was normal. However, the X-ray and CT scan showed diastasis of the sutures. His recovery was uneventful

CASE REPORT

A 65 year old male patient presented to our casualty department as a victim of head injury resulting from a trivial fall. He complained of headache but clinical examination including neurological examination was entirely normal. Glasgow coma scale was scored as fifteen and remained so thereafter. Radiographs of the skull revealed diastasis of all sutures-coronal, sagittal and lambdoid without any fractures. Emergency CT scans confirmed the same but did not demonstrate presence of intracranial haemorrhage. Following neurosurgery opinion this patient was admitted for observation and had an uneventful hospital stay.

Fig 1
Fig 1 : An Antero-posterior radiograph showing diastasis of coronal sutures
 
Fig 2
Fig 2 : An Antero-posterior radiograph showing diastasis of sagittal and lambdoid sutures
 
Fig 3
Fig 3 : A CT scan picture showing the disatasis in transverse section.
 

DISCUSSION

A previously unreported case of pan-sutural skull diastasis is described. This unusual sequelae following head trauma in adults is not found in literature although anecdotal cases involving isolated sutures have been described in much younger patients. Almost without exception these patients have been treated non-operatively and have gone onto a full recovery. This case highlights the controversy surrounding skull radiographs done without localising signs and emphasizes the need for a high degree of suspicion for apparently "trivial trauma" in the elderly.

REFERENCES

1. Oyen OJ, Melugin MB, Indresano AT. Strain guage analysis of the frontozygomatic region of the zygomatic complex. Journal of Maxillofacial Surgery September 1996; 54 (9) : 1092-5; discussion 1095-6.

2. Wang EC, Lim AY, Yeo TT. Traumatic posterior fossa extradural haematomas (PFEDH). Singapore Medical Journal March 1998; 39 (3) : 107-11.

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