Fig. 1

Imaging on initial presentation: A: Coronal CT demonstrating left parasagittal intracranial air as a sign of a dural defect; B: Axial CT (bone window) demonstrating the bone defect, a bone splinter and the depth of the skin defect; C: Sagittal CT again showing the bone splinter entering the frontal lobe as well as the sagittal extent of the scalp and bone defect; D: Coronal MRI showing gadolinium enhancement underneath the defect as a sign of encephalitis; E: Sagittal MRI demonstrating the extent of brain involvement