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Images in Neurology
May 10, 2021

Flapping Scalp Sign as a Rare and Interesting Presentation in Delayed Postoperative Tension Pneumocephalus

Author Affiliations
  • 1Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal
  • 2Department of Surgery, College of Medical Sciences, Chitwan, Nepal
JAMA Neurol. 2021;78(7):874-875. doi:10.1001/jamaneurol.2021.1149

A 35-year-old man presented to our neurosurgery clinic with the complaint of a progressive headache associated with the abnormal movement of his scalp at a previously operated site. The patient had sustained a head injury, resulting in a compound, depressed, comminuted right frontal bone fracture involving the frontal sinus, with an underlying frontal contusion and subdural pneumocephalus, 1 month previous to his presentation (Figure 1). He had undergone debridement of the wound with the removal of the comminuted bone fragments. There were multiple dural tears resulting from the depressed bone fragments. The removal of only the contused brain egressing from the dural defects was undertaken, followed by the placement of a dural substitute. The exenteration of the involved frontal sinus was carried out. The skull defects were repaired with a titanium mesh cranioplasty.

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