PMC4352644_01
CT scan brain showing left parietal bone hyperostosis with subdural collection, focal cerebral oedema, mass effect, midline shift and small hyper densities in parietal lobe
AJNS-10-56b-g001.jpg
PMC4352644_01_AJNS-10-56b-g001.jpg
F1
The overlying bone showed hyperostosis with intermittent punched out defects [Figure 1].
(a&b) MRI brain T1W and T2W axial section showing relieved mass effect with subcutaneous collection at operative site and no parenchymal lesion. (c, d and e) T1W post contrast of brain showing enhancement of subcutaneous collection at operative site
AJNS-10-56b-g002.jpg
PMC4352644_01_AJNS-10-56b-g002.jpg
F2
Subsequent magnetic resonance imaging (MRI) showed adequate excision along with a resolution of mass effect [Figure 2].
(a) Intraoperative picture showing subcutaneous tissue entering into brain through small whole in parietal bone (no external sinus to the skin). (b) removed parietal bone with bony destruction and punched out appearance
AJNS-10-56b-g003.jpg
PMC4352644_01_AJNS-10-56b-g003.jpg
F3
The dura was thickened and was an adherent to the bone that was punched out at various places [Figure 3].
(a) photomicrograph showing granule with pale center and splender-hopple phenomenon amidst suppurative inflammation. Hematoxylin and eosin x4 Inset showing eosinophilic material in the periphery of the granule with neutrophils clinging to it Hematoxylin and eosin x40. (b) Photomicrograph showing filamentous hyphae in the center of the granule periodic acid schiff x40. (c) Photomicrograph showing filamentous hyphae in the centre of the granule and vesicles in the periphery-Gomori s methenamine silver stain x40
AJNS-10-56b-g004.jpg
PMC4352644_01_AJNS-10-56b-g004.jpg
F4
The central pale area was composed of vesicles and septate hyphae, highlighted on Gomori methenamine silver stain and periodic acid-Schiff stain [Figure 4].