Presentation
Severe encephalopathy after meningitis during first year of life. Refractory epilepsy. Many years of phenytoin use.
Patient Data
Age: 30 years
Gender: Female
From the case:
Calvarial thickening from chronic phenytoin use
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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 disease
- hyperparathyroidism
- anemias
- 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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