XXXX with @entity1319 : dramatic improvement after cranioplasty.

@entity1 @entity4282 @entity3308 @entity308 @entity1276 @entity428 @entity130 @entity73 @entity16 @entity542 @entity1295 @entity51 @entity281 @entity735 @entity10 @entity1319
BACKGROUND: @entity1 with skull defects sometimes develop @entity51 , which have been grouped under "the syndrome of the trephined". The deficits are usually nonspecific or nonlocalizing, such as apathy or @entity10 . We report, to our knowledge, a first case of severe @entity3308 associated with a skull defect. Cranioplasty dramatically resolved the @entity1 's symptoms. A @entity3308 represents the main manifestation of the syndrome of the trephined and can be corrected by cranioplasty. CLINICAL PRESENTATION: A 38-year-old @entity1 with @entity542 and @entity4282 initially had @entity1319 . He developed a skull defect after @entity281 following cranioplasty. He presented with onset of neurological symptoms one year after @entity542 with a skull defect, a small divergent and vertical strabismus, elevation @entity735 , @entity10 and @entity1295 . Over several months he developed severe bilateral deficit of adduction, elevation, @entity308 and convergence. He had @entity51 , @entity1295 , @entity10 and @entity73 . Neuroimaging and lumbar puncture did not show evidence of @entity428 or @entity1276 . INTERVENTION: Cranioplasty using Palacos was performed one-and-a-half years after @entity130 . Immediately after surgery, the @entity1 noted remarkable improvement in his symptoms. @entity10 and @entity1295 disappeared within two days. Two weeks after cranioplasty the @entity1 had orthotropia and virtually normal ocular motility. @entity16 completely disappeared. Recovery remained sustained for over 5 years after cranioplasty. CONCLUSION: To our knowledge, this represents the first case of the syndrome of the trephined in which the @entity51 map primarily to the brainstem and show rapid improvement following cranioplasty. We show that cranioplasty in @entity1 with large skull defects is indicated for more then cosmetic reasons and should be considered even after longer periods following a @entity130 .
