Layer cake skull

Last revised by Rohit Sharma on 11 Feb 2024

The layer cake skull refers to the CT appearance of layered diffuse calvarial hyperostosis in a distinct concentric pattern deep to the inner table of the skull seen most frequently in the setting of spontaneous intracranial hypotension although it is also sometimes encountered in normal individuals 2.

A layer cake skull appearance is seen in 14-32% of patients with spontaneous intracranial hypotension but only in 5% of controls 1,2. It has also been described in pediatric patients who have ventricular shunts 3.

It is hypothesized that this layered hyperostosis occurs due to chronic, but presumably variable, intracranial hypovolemia resulting in increased bony deposition during times of maximal hypotension. The exact mechanism, however, remains to be determined 2.

On bony algorithm CT of the skull, the skull vault is thickened with discernable layers of new bone seen internally 1,2. This is in contrast to more common hyperostosis frontalis interna where no such layering is present 2.

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