title: Traumatic elevated vertex fracture with delayed increase in intracranial pressure: a rare case.
abstract: BACKGROUND
  Skull fractures are traditionally classified into linear, comminuted or depressed which can either be simple or compound. A skull fracture where the bone fragment is elevated above the intact skull known as elevated skull fracture has been reported infrequently in literature.
  
  
  METHODS
  We report a unique case of simple elevated vertex fracture in a 3-month-old child where the vertex had separated from the calvarium and was elevated above the level of outer table in a patient with delayed neurological deterioration. Cerebrospinal fluid leak into tight subgaleal space and gradual thrombosis of superior sagittal sinus could have led to late clinical deterioration.
  
  
  CONCLUSIONS
  Prolonged monitoring, probably early repair of dural tear and aggressive management of raised ICP, is required. Reduction of fracture with careful manipulation of SSS should weigh the risk of exsanguination. No such case of an elevated vertex fracture has been reported so far in the literature.
authors.affiliation: Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
authors.forename: Uday Singh
authors.initials: US
authors.lastname: Raswan
authors.affiliation: Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India. sarabjitchhiber@gmail.com.|Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, First floor room no 1312, Soura, Srinagar, Jammu and Kashmir, 190011, India. sarabjitchhiber@gmail.com.
authors.forename: Sarbjit Singh
authors.initials: SS
authors.lastname: Chhiber
authors.affiliation: Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
authors.forename: Altaf U
authors.initials: AU
authors.lastname: Ramzan
mesh_terms: D006801:Humans; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D012886:Skull / Q000000981:diagnostic imaging / Q000473:pathology*; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
keywords: Csf collection; Elevated vertex fracture; Late deterioration; Sinus thrombosis