Armoured brain of unknown etiology

Abstract

Armoured brain is a rare condition where dense calcification occurs over the brain. It can result in mass effect and raised intracranial pressure. Most often, it happens due to trauma, subdural effusion, infection, or after VP shunt. There is controversy in its treatment. Most published literature does not support removing the calcification. We describe a rare case of idiopathic chronic calcified subdural hematoma with relatively short history which was successfully treated by microsurgical removal of calcification over the brain. This resulted in complete expansion of the brain with relief in symptoms.

An early presentation of a large calcified chronic subdural hematoma presenting as an inner eggshell in an elderly patient: A case report

“…Various etiologies of the calcification have been reported. These included traumatic subdural hematoma, secondary to ventricular shunting procedure, post-meningitis or encephalitis, and tumors of central nervous system [ 2 , [4] , [5] , [6] , [7] ]. It seems that our patient’s lesion was caused rather by trauma than other causes.…”

Armored brain associated with secondary craniostenosis development at 7-year following ventriculoperitoneal shunt surgery during infancy: Extremely unusual association and review

“…A calcified chronic subdural hematoma (CCSDH) is extremely uncommon occurrence. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 ] Calcification in a traumatic subdural hematoma is relatively more common than the subdural collections of postmeningitic and VP shunt origin. It is more frequently seen in children though it has been described in all age groups.…”

“…An underlying poor circulation, metabolic abnormality, and craniostenosis are possible hypothesis for development. [ 1 2 ]…”

“…It can present with features of raised intracranial tensions such as headache, vomiting, failure to thrive, seizures, and even rarely mental retardation. [ 1 3 ] Unlike to adult, CCSDH in children may present with seizures and mental retardation; however, many asymptomatic cases are also picked up incidentally. [ 5 ] The clinical presentation of patients with “armored brain” is characterized by a slow progression of neurological signs and symptoms.…”

“…Calcification is considered uncommon in chronic subdural hematoma and observed in about 0.3%–2.7% of cases of chronic subdural hematoma. [ 1 2 ] This complication has been rarely reported in cases suffering with hydrocephalus treated with shunt surgery. [ 1 3 4 ]…”