Armoured brain: Calcified chronic subdural haematoma

A young male presented with complaints of intermittent headache for nine months following head trauma. The plain computed tomography (CT) scan of the head showed left-sided calcified chronic subdural haematoma, also known as ‘armoured brain’ (Fig. 1).¹ This is a rare radiological finding, and is a long-term sequela of subdural haematoma subsequent to head trauma. It accounts for only 0.3% to 2.7% of chronic subdural haematomas.² The interval between an acute haematoma and calcification may vary from 6 months to many years.³ The periphery of the haematoma uniformly calcifies, giving the appearance of an armoured brain.⁴ Calcified subdural haematomas are often found after shunting of large ventricles in children.⁵ Neurosurgical intervention is indicated only in patients with mass effect and intractable severe headaches, consequent to raised intracranial pressure (ICP). Excision of the haematoma can be difficult because the calcified haematoma capsule often adheres to the leptomeninges and underlying cortex, which precludes a radical excision of the calcification without resulting in iatrogenic neurological deficits. The index case was managed conservatively after raised ICP was ruled out as the cause for headache. He was followed up with repeat CT scans of the head, which did not show any further increase in haematoma or mass effect.

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FIG 1.

Plain computed tomography of the head showing left fronto-temporo-parietal calcified chronic subdural haematoma

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