CHRONIC SUBDURAL HEMA TOMA PRESENTING AS MULTIPLE SCALP SWELLINGS: REPORT OF AN UNUSUAL CASE Naim-Ur-Rahman, DLO (London), FRCS(Eng), FRCS(Ed):

The caseof achild who had multiple progressively enlarging"scalp " swellingsassociatedwith rapidly risiJlQ;intracranial pressurefollowing ahead injury is.~,orted. Unusual computerized tomographic (CT) scan findings of this atypical chronic sub-dural hematoma/hygroma and its surgical man-agementare discussed.The relationship between chronic subdural hematoma and subdural hy-groma and their etiopathogenesisare reviewed. Chronic subdural hematomain the infant repre-sentsoneof themostcommonand the leastunder-stood entities in pediatric traumatology [1]. Etiopathogenesis, natural history and manage-mentof chronic subduralhematoma,hygromaand "growing skull fractures " remains controversial. Our case representsa complicated clinical condi-tion with atypical features of all these three entities. Rapid growth of subdural fluid collection and skull fracturesled to a rapidly enlarging head wit ~xtracranialherniations of subdural space through gaping skull fractures. Massive extracerebral fluid collection caused a rapid increaseof intracranial pressure (lCP) with gross cerebral damage and atrophy secondary to pres-sure from without (as opposed to pressure from within by hydrocephalus). Rapid progression and growth of subdural collection with a malignant course in our case representsone end of a spec-trum, of which the other extreme is marked by