crainal malformation

not sure how i got a question in the ms section--

my question is
i have an eighteen year old amish, female patient with normal neuro exam
pt states she recently noticed a hole in her head.  There is are two depressions, one being atleast 1 cm wide and deep, jagged 7 cm long, not straight-- lateral of the crown on the patients right side of the skull--the second running somewhat paralel same wideth and depth, along only 3 cm long.. Pt has no known history or knowledge of trama or fall--  neuro exam  unremarkable though history of "mild headaches" once a week


any ideas??

[Lulu54]

Welcome anyway even though this isn't where you wanted to go....

7cm is a pretty significant gash.

Can we assume that the pt would have been honest when questioned about trauma?  My instinct tells me this is an injury, and if she doesn't want to speak of it, perhaps she is afraid?

If its not an injury  then I haven't a clue.

Diagnostic imaging would be the next step - even though electricity is shunned in their community would they go to the hospital and be treated?  It would be hard to run an MRI off a portable generator.

If you figure this out, please come back and let us know the answer.

my best,
lulu

[Lulu54]

ok, I went and did a quick look- try this idea:

"More like a nutritional concern (the dent). Dents can even change shape throughout the day. Check for food allergies/intolerances." source: wikiAnswers

[ShadowsSister]

Like I have said many times, you are ONE AMAZING LADY... Your insight and care go far beyond the norm... We would be so much less than we are as a group with out you..

I thank God every day for bring you & me together... you being there makes my days so much better...

{{{{~!~}}}}

[Lulu54]

Thanks DJ, you would do the same if a stranger came to your door and needed your help!

feel better,
L

[PastorDan]

My instincts pointed the same way as Lulu's.  Maybe her second post will pan out; I'd hate the think that someone has abused the girl, though it wouldn't be the first time.