Sunday 15 January 2012

Multiple sclerotic lesions skull

A 65 yo female with a breast nodule under evaluation. Brought in casualty with recent onset seizures.
Her CT study of brain shows Multiple Sclerotic focal lesions in bony calvarium.
Possibility suggested was Osteoblastic metastasis to bony calvarium in view of the Breast nodule.
Brain brain parenchyma show normal attenuation. Even Axial FLAIR images of brain done to rule out any parenchymal metastasis, revealed no significant signal abnormality in brain parenchyma.

Follow up :
Breast nodule biopsy and histopathology revealed no obvious malignancy.
Blood reports revealed Hyper calcemia, which evaluated further with radionucleid study revealed a Parathyroid Adenoma and Hyperparathyroidism.

In addition to multiple Sclerotic focal lesions there is diffuse thickening of bony calvarium.
Apart from Osteoblastic metastasis one should try to add Hyper parathyroidism in the list of DDs though uncommon to present with these kind of isolated multiple sclerotic lesions. 


Anonymous said...

hi we had a similar puzzling case ..thnx to your article we were able to reach d final diagnosis..

rad said...

indeed its an exciting dd we found it helpfull in another similar PUZZLING case
thnkyou for this presentaion ..