1 materials and methods
14 cases were all female, aged 60-74 years, with an average of 65 years. Except for 3 cases of head trauma, the rest 1 1 cases had a history of dizziness. The longest medical history 1 year, in which 5 cases came to the hospital because of headache and 6 cases came to the hospital because of unilateral limb weakness. All of them had a history of hypertension in the past, and 9 cases had a history of diabetes, all of them were overweight, and all of them were menopausal after gynecological examination. Laboratory examination showed that there was no abnormality in biochemical examination except 9 cases with elevated blood sugar and urine sugar (+).
Two results
Two patients underwent routine X-ray and brain CT scanning, three patients were treated with Picker 1200EX whole-body CT machine with scanning coefficients of 120KV and 65MA, and the rest 1 1 patients were treated with somatom Huanyue whole-body spiral CT machine with scanning coefficients of 130KV and 260MAS. 14 cases, the lesions were bilateral frontal bone involvement. X-ray plain film showed diffuse thickening of the inner plate of frontal bone with clear edge, 8 cases were spindle-shaped with smooth inner edge, and 6 cases were uneven and nodular thickening of the inner edge of frontal bone. The inner edge is blurred and does not cross the coronal seam. There is no abnormality in the structure of parietal bone, occipital bone and skull base, and there is no abnormality in the craniocervical junction such as skull base depression and skull base flattening. On plain CT scan, the inner plates of bilateral frontal bones were spindle-shaped, thickened into nodular masses, with the maximum thickness of more than 65438±0cm, without crossing the midline and coronal suture, and no obvious thickening of the outer plates was found. 1 case showed spindle-shaped symmetrical thickening of bilateral frontal bone inner plates; In 3 cases, the inner plate of frontal bone was nodular and massive thickening, and it was also symmetrically distributed. In 2 cases, the inner plate of frontal bone was spindle-shaped nodular and massive with asymmetric thickening; In another case, 1, one side of the medial plate of the frontal bone was spindle-shaped and the other side was nodular thickening. All of them had brain atrophy and adjacent brain parenchyma was pushed, and subarachnoid space was narrow. Left basal ganglia lacunar infarction in 5 cases, right basal ganglia lacunar infarction in 3 cases, bilateral lenticular calcification 1 case.
3 discussion
Frontal Hypertrophy International (HFI) is more common in middle-aged and elderly women, most of whom are postmenopausal women, and it is extremely rare in men. This disease is more common in women in Europe and America, and less reported in Asia [1].
HFI has no clinical symptoms at all, but occasionally X-ray or CT scan or physical examination shows that the medial plate of frontal bone is evenly or unevenly thickened, does not cross the midline and cranial suture, and is accompanied by displacement of adjacent brain parenchyma. The thickened medial plate is only limited to the scales and nodules of the frontal bone, and does not involve the skull base bones such as the orbital plate of the frontal bone and the ethmoid saddle. The etiology of the disease is still unknown, which may be related to abnormal bone metabolism or endocrine hormone secretion disorder [2]. Chaljub and others think that HFI is a benign skull sclerosis-like change and a normal variation. Some literature reports can produce some clinical symptoms, such as headache and obesity. Chen Zupei also called it obesity hirsutism and frontal thickening syndrome. But so far, the cause of the disease is still not very clear. The clinical symptoms reported in literature, such as obesity, hypertension, diabetes, hirsutism and some nervous system symptoms, are also common symptoms and signs of middle-aged and elderly patients. So far, it has not been confirmed whether there is an inherent and inevitable connection between HFI and HFI. The author thinks that the headache and dizziness of some patients may be related to the excessive thickening of the inner plate of the frontal bone, which leads to the reduction of the bone mass of the anterior cranial fossa and compression to the adjacent frontal lobe brain parenchyma, while the frontal lobe area of the cerebral hemisphere is relatively blind in function, so the relatively fine dysfunction is not obvious. The X-ray and CT manifestations of HFI are typical, but the CT images are particularly intuitive: the bilateral medial plates of frontal bone are diffusely thickened and proliferated, without involving the skull base and lateral plates, and without crossing the midline and suture. The correct diagnosis can be made in this group 14 cases, and some laboratory tests are within the normal range. Combined with its special imaging manifestations, a correct diagnosis can be made. In some cases, the thickening of the inner plate is not limited to the frontal bone, and it has been reported that the inner plate of the parietal bone is involved. According to the proliferation morphology and involved range of the inner plate, HFI can be divided into three types: type I, that is, the inner plate of frontal bone is symmetrically thickened, and can be divided into two subtypes, type IA, that is, the inner plate is symmetrically thickened in a spindle shape, and type IB, that is, the inner plate is symmetrically thickened in a nodular shape. Type Ⅱ, that is, asymmetric thickening, type Ⅱ A inner plate thickening, spindle-shaped on one side and nodular on the other, type Ⅱ B nodular thickening, but the degree is different. Type ⅲ, namely diffuse thickening type, is accompanied by thickening of parietal inner plate on the basis of type ⅰ and type ⅱ.
There are few reports of HFI in China, and the clinical symptoms are not specific, but the imaging characteristics are typical, so it is not easy to miss the diagnosis after understanding the condition. The author thinks that the cause of the disease may be related to the endocrine hormone secretion or metabolic disorder of elderly female patients, and it is most likely that estrogen production and metabolism disorder, but it needs further confirmation. The significance of understanding the disease mainly lies in its differential diagnosis to avoid misdiagnosis and missed diagnosis. HFI must be differentiated from the following diseases: ① Osteoma of frontal bone, which is easy to be confused, but the density of dense osteoma is higher than HFI, and it is ivory-like. Osteoma of cancellous bone is sometimes difficult to distinguish, but osteoma is more common on one side. ② paget's disease, that is, deformed osteitis, full-thickness skull involvement, diffuse sclerosis, flocculent thickening of internal and external plates and baffles, with depression of skull base. ③ Adult pituitary growth hormone adenoma, that is, finger tip hypertrophy, skull cap thickening, baffle widening, sinus gasification and mandibular protrusion. ④ Bone fibrous dysplasia, characterized by large-scale symmetrical or plastic hyperosteogeny of skull base bone in the horizontal part of the frontal bone, and multiple cystic low-density areas in the vertical part of the frontal bone, often involving the contralateral bone across the midline. ⑤ Osteoporosis, diffuse osteosclerosis of craniofacial bone, especially in the skull base, forming a interbedded vertebra.
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[1] ten thousand. X-ray and CT diagnosis of intrafrontal hyperplasia. Journal of Clinical Radiology, 2004, 23: 64 1.
[2] Almeragos G, chrisman OD. International frontal bone hypertrophy: Nubian case, American Journal of Human Physics, 1988, 76:25. ;