Neurologic Deterioration in Sinking Skin Flap Syndrome After Diuretic Therapy

Abstract

The sinking skin flap syndrome (SSFS), or syndrome of the trephined, is a pathologic condition arising from the presence of large bone defects of the skull. Originally described by Grant and Norcross1 in patients with a skin flap depression after craniectomy, SSFS has a multifaceted clinical presentation, including chronic fatigue, headache, dizziness, impaired vigilance, motor deficits, cognitive deficits, epileptic seizures, and visual symptoms.2 SSFS pathophysiology is related to the atmospheric pressure exerted on the brain through the craniectomy, inducing brain compression, changes in the CSF dynamics, impaired venous return, and decrease in the regional blood flow, alone or in combination.2 In this report we describe a case of SSFS complicated by paradoxical uncal herniation due to diuretic therapy.