365 Subdural Haematoma Associated with a Dandy-Walker Malformation in an Adolescent Karate Athlete - a Case Report
J Wellington, L Valéry C Estrada- Surgery
Abstract
Introduction
The Dandy-Walker Malformation (DWM), retrospectively named after Walter Dandy and Arthur Walker as failure to perforate the Luschka and Magendie Foramina, is believed to be the absence of an aperture of the posterior membranous area. Said incidence is reported between 1:25000-1:35000 live births. We describe an unusual case of an adolescent who suffered a moderate traumatic brain injury (TBI) while practising karate presenting with an acute subdural haematoma (ASH) associated with a DWM.
Case Report
A fifteen-year-old Mexican adolescent with depression and anxiety presented to the emergency department 30 minutes post-direct head trauma during a karate competition. At first evaluation, the patient exhibited GCS 14 with bifrontal headache, disorientation, and six episodes of projectile vomiting. CT head revealed a right ASH with 10mm thickness and a 5.7mm midline shift. Posterior fossa malformation characterised by vermis hypoplasia and 4th ventricle cystic dilatation was also observed. An emergency craniotomy was performed, finding an ASH associated with Labbe Vein rupture near its transverse sinus drainage. Post-intervention, the patient was transferred to ICU and made an excellent recovery, discharged 2 weeks post-TBI without neurological sequelae.
Discussion
DWM is the most prevalent cerebellar malformation in humans, linked to psychiatric conditions comprising refractory schizophrenia, poor impulse control, and depression. Approximately 90% develop hydrocephalus with associated anomalies such as corpus callosum agenesis and posterior cerebellar vermis. In karate, the most frequent injuries are haematomas and tooth avulsion/subluxation. To our knowledge, this is the first case of ASH with an associated DWM in a karate athlete.