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: 30 years
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:

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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