Rare case of closed depressed fracture of the posterior fossa in an adult causing brainstem dysfunction: management dilemmas.

摘要

Depressed fractures in adults are rare in the posterior fossa because of multiple layers of muscle and soft tissue covering the suboccipital region. We report one such case who succumbed to brainstem dysfunction. A 35-year-old man, a pedestrian, was allegedly hit by atractor from front, fell back on his head and lost consciousness. Examination revealed a Glasgow coma scale (GCS) score of E2 M5 V2, normal reacting pupils, intact brainstem reflexes and no focal deficits. Computer tomography (CT) scan of the head done 11 h post-trauma showed a closed suboccipital region depressed fracture with a speck of left cerebellar contusion and no associated hydrocephalus [Figures 1a-e]. He was managed conservatively with anti-edema measures. Repeat CT scan at 23 h revealed no increase in cerebellar contusion or ventricular size.