title: Low-grade infection complicating silastic dural substitute 32 years post-operatively.
abstract: BACKGROUND
  A complication of a silastic dural substitute is described, which appeared after 32 years-by far the longest latency period reported in the literature.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  In 1971, a 20-year old woman suffered from an acute subdural haematoma and a temporal cerebral contusion due to a motorbike accident. She underwent an operation with evacuation of these and the dura was mended with a silastic duraplasty. Thirty-two years later she deteriorated with increased memory problems and dysphasia. CT revealed an expanding haemorrhagic mass around the previous duraplasty, which demanded surgery with removal of the silastic dural implant and evacuation of the haemorrhagic mass. Although the haemorrhagic mass enveloped the silastic implant, a contribution of the acrylate flap cannot be ruled out. Bacteriological cultures revealed Acinetobacter spp. in the CSF. Adequate post-operative antibiotic treatment was administered. The patient slowly improved, but the complication represented a major setback in her long-term cognitive and communicative functions.
  
  
  CONCLUSIONS
  This case widens the previously reported time-frame of late complications by 60%, from 20 to 32 years, and will hopefully serve to increase the awareness of late infections and haemorrhages induced by silastic dural implants, thereby improving diagnosis and treatment in future cases.
authors.affiliation: Department of Clinical Chemistry, Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: J O
authors.initials: JO
authors.lastname: Ström
authors.forename: S
authors.initials: S
authors.lastname: Boström
authors.forename: L
authors.initials: L
authors.lastname: Bobinski
authors.forename: A
authors.initials: A
authors.lastname: Theodorsson
mesh_terms: D002543:Cerebral Hemorrhage / Q000503:physiopathology / Q000601:surgery*; D004388:Dura Mater / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000150:complications*; D012826:Silicone Elastomers / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D012826:Silicone Elastomers