{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:38:34Z","timestamp":1792543114986,"version":"4.5.0"},"reference-count":11,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,10,19]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Skull infarction is a rare sickle cell disease (SCD) complication. While epidural hematomas from calvarial infarction have been sporadically reported, subdural collections and sterile exudates mimicking intracranial empyema remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 6-year-old boy with nonverbal autism and SCD presented with progressive periorbital swelling, fever, and extremity pain. CT raised concern for orbital cellulitis, subperiosteal abscess, and subdural empyema. MRI revealed a diffuse heterogeneous calvarial marrow signal with multifocal nonenhancement and restricted diffusion consistent with bone infarction, alongside right convexity subdural fluid and bilateral epidural and subperiosteal rim-enhancing collections demonstrating susceptibility artifacts. Emergency craniotomy and orbital exploration yielded hemosiderin-stained fluid, and necrotic bone without purulence. All operative cultures were negative. Postoperative imaging demonstrated expansion of the subdural collection to 8 mm with 6\u20137 mm of midline shift, managed with dexamethasone. Nine months later, the patient re-presented with recurrent subperiosteal hemorrhage without infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Calvarial infarction in SCD can produce sterile collections that mimic infectious processes. Intraoperative findings and culture data are essential in distinguishing these entities. Middle meningeal artery embolization warrants caution in SCD patients, given the risk of moyamoya vasculopathy. This case underscores the importance of a broad differential when evaluating SCD patients with periorbital swelling and intracranial collections.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26291\">https:\/\/thejns.org\/doi\/10.3171\/CASE26291<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26291","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:01:05Z","timestamp":1791936065000},"source":"Crossref","is-referenced-by-count":0,"title":["Skull infarction and chronic subdural exudates in a pediatric patient with sickle cell anemia: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Thach-Vu","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Maryland School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Rakovec","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan R.","family":"Saadon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven K.","family":"Yarmoska","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3868-3287","authenticated-orcid":true,"given":"Regina","family":"Macatangay","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Maryland School of Medicine, Baltimore;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0527-1593","authenticated-orcid":true,"given":"Noushin Yahyavi-Firouz-","family":"Abadi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8903-6096","authenticated-orcid":true,"given":"Whitney E.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore;"},{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1073","key":"bib1","series-title":"Br J Radiol","first-page":"20160130","article-title":"Imaging of musculoskeletal manifestations in sickle cell disease patients","volume":"90","author":"Kosaraju","year":"2017","unstructured":"Kosaraju VHarwani APartovi SImaging of musculoskeletal manifestations in sickle cell disease patients. Br J Radiol. 2017;90(1073):20160130. doi:10.1259\/bjr.20160130"},{"key":"bib2","series-title":"Clin Imaging","first-page":"15","article-title":"T2-blackout effect on DWI as a sign of early bone infarct and sequestration in a patient with sickle cell disease","volume":"54","author":"Tuna","year":"2019","unstructured":"Tuna ISTarhan BEscobar MAlbayram MS.T2-blackout effect on DWI as a sign of early bone infarct and sequestration in a patient with sickle cell disease. Clin Imaging. 2019;54:15-20. doi:10.1016\/j.clinimag.2018.11.006"},{"key":"bib3","series-title":"Int J Surg Case Rep","first-page":"109255","article-title":"Massive spontaneous subdural hemorrhage mimicking dural venous thrombosis in a sickle cell adolescent, a rare case report","volume":"115","author":"Chipongo","year":"2024","unstructured":"Chipongo HSarkar ABosco KSangey E.Massive spontaneous subdural hemorrhage mimicking dural venous thrombosis in a sickle cell adolescent, a rare case report. Int J Surg Case Rep. 2024;115:109255. doi:10.1016\/j.ijscr.2024.109255"},{"issue":"2","key":"bib4","series-title":"Asian J Transfus Sci","first-page":"241","article-title":"A case series of hemorrhagic neurological complications of sickle cell disease: multiple faces of an underestimated problem!","volume":"15","author":"Kamath","year":"2021","unstructured":"Kamath SDPai MG.A case series of hemorrhagic neurological complications of sickle cell disease: multiple faces of an underestimated problem! Asian J Transfus Sci. 2021;15(2):241-246. doi:10.4103\/ajts.AJTS_101_18"},{"key":"bib5","series-title":"Front Pediatr","first-page":"38","article-title":"Life-threatening infectious complications in sickle cell disease: a concise narrative review","volume":"8","author":"Ochocinski","year":"2020","unstructured":"Ochocinski DDalal MBlack LVLife-threatening infectious complications in sickle cell disease: a concise narrative review. 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