Copper beaten skull
Copper beaten skull, also known as beaten silver skull or beaten brass skull, refers to the prominence of convolutional markings (gyral impressions on the inner table of the skull) seen throughout the skull vault.
The appearance of copper beaten skull is associated with raised intracranial pressure in children. Convolutional markings may be normal but are usually confined to the posterior part of the skull's inner table.
Raised intracranial pressure is (at least in part) the causative mechanism behind increased inner table markings that give rise to the copper beaten skull appearance. Hence, a pathology that causes raised intracranial pressure may be the primary cause of copper beaten skull; these include, but are not limited to:
Rather than the inner table of the skull being smooth, there are convolutions that overlie the gyri. As described above (and seen in the differential diagnosis case), convolutional changes may be normal if they are confined to the posterior calvaria and are subtle.
3D volume rendered reformats demonstrate a calvaria with similar appearances to hand-beaten copper pot bottoms.
On imaging consider:
- 1. Tuite GF, Evanson J, Chong WK et-al. The beaten copper cranium: a correlation between intracranial pressure, cranial radiographs, and computed tomographic scans in children with craniosynostosis. Neurosurgery. 1996;39 (4): 691-9. Neurosurgery (link) - Pubmed citation
- 2. Rühli FJ, Nicklisch N, Alt KW. A historical case of beaten-copper cranium. J. Neurosurg. 2007;106 (1 Suppl): 71-3. doi:10.3171/ped.2007.106.1.71 - Pubmed citation
- 3. Shahdadpuri R, De vries B, Pfundt R et-al. Pseudoarthrosis of the clavicle and copper beaten skull associated with chromosome 10p11.21p12.1 microdeletion. Am. J. Med. Genet. A. 2008;146A (2): 233-7. doi:10.1002/ajmg.a.32088 - Pubmed citation
- 4. Agrawal D, Steinbok P, Cochrane DD. Significance of beaten copper appearance on skull radiographs in children with isolated sagittal synostosis. Childs Nerv Syst. 2007;23 (12): 1467-70. doi:10.1007/s00381-007-0430-6 - Pubmed citation