PT  - JOURNAL ARTICLE
AU  - Padma John Pramila
AU  - Pavithra Mannam
AU  - Ari George Chacko
AU  - Rohit Ninan Benjamin
TI  - Progressive midbrain clefts after head trauma and decompressive surgery: a report of two patients
AID  - 10.1136/bcr-2020-238893
DP  - 2021 Feb 01
TA  - BMJ Case Reports
PG  - e238893
VI  - 14
IP  - 2
4099  - http://casereports.bmj.com/content/14/2/e238893.short
4100  - http://casereports.bmj.com/content/14/2/e238893.full
SO  - BMJ Case Reports2021 Feb 01; 14
AB  - This report describes two patients with acute-onset ptosis, oculomotor dysfunction, ataxia and drowsiness, referable to the midbrain tegmentum. Both patients had previously suffered severe closed head injuries requiring craniotomy for cerebral decompression. Serial brain scans in both cases revealed a newly developing cleft in the midbrain, with features suggestive of abnormal cerebrospinal fluid (CSF) flow across the aqueduct. A trial of acetazolamide was initiated to reduce CSF production, followed by a third ventriculostomy for CSF diversion in one patient, which resulted in arrested disease progression and partial recovery. There are only two previous reports in the literature of midbrain clefts that developed as remote sequelae of head trauma. We postulate that altered CSF flow dynamics in the aqueduct, possibly related to changes in brain compliance, may be contributory. Early recognition and treatment may prevent irreversible structural injury and possible death.