Calvarial thickening from chronic phenytoin use

Case contributed by Dr Bruno Lorensini

Presentation

Severe encephalopathy after meningitis during first year of life. Refractory epilepsy. Many years of phenytoin use.

Patient Data

Age: 32
Gender: Female

Hypoattenuation with density close to CSF in cortical and subcortical bilaterally, especially on the left hemisphere, related encephalomalacia.

Diffuse thickening of the skull and facial bones, along with the usual loss of trabecular bone.

Cerebellar atrophy.

Case Discussion

There are many causes of calvarial thickening:

  • idiopathic
  • Paget´s disease
  • hyperparathyroidism
  • anaemias
  • osteopetrosis

Chronic use of phenytoin should be remembered as a cause (as it was in this case) when the combination of cerebellar atrophy and diffuse calvarial thickening are present.

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Case Information

rID: 35693
Case created: 16th Apr 2015
Last edited: 13th Jun 2016
Tag: skull
Inclusion in quiz mode: Included

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