# Double Skull Sign After Cranioplasty: A Case Report

## TL;DR

A 46-year-old woman who had a brain surgery developed a rare imaging appearance called the double skull sign, which was linked to her surgical history rather than a blood clot.

## Contribution

This case report presents a novel etiology of the double skull sign related to cranioplasty rather than calcified hematomas.

## Key findings

- The double skull sign in this case was attributed to cranioplasty rather than hematoma calcification.
- The patient's imaging showed both cerebral infarction and the double skull sign.
- This case expands the understanding of possible causes for the double skull sign.

## Abstract

The double skull sign (DSS) is a unique image on the outside of the brain that looks like two skulls. Whereas congenital and acquired types of DSS have been reported, the etiology of both of them is calcified hematomas. We encountered a case of a 46-year-old woman with a history of subarachnoid hemorrhage followed by cranioplasty at 43 years old. She developed right hemiparalysis and motor aphasia suddenly. Brain computed tomography and magnetic resonance imaging revealed not only cerebral infarction but also DSS incidentally. After detailed analysis, we concluded that the DSS in this case was not due to calcification of the hematoma but was related to the cranioplasty. In this report, we present an interesting case and discuss etiologies of the development of DSS after cranioplasty.