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Skull thickening (ST)
Diploic space expanded ± thickened cortex
Widened calvaria (skull width)
Can be diffuse or focal
NECT best for most causes of ST
Thin-section bone CT for detailed skull base evaluation
MR C+ contrast: Look for adjacent dural involvement
Normal variation (most common cause)
Shunted hydrocephalus or infantile brain injury
Neonatal meningitis or cerebritis
Hypoxia/ischemia/hypoglycemia in neonatal period
Metabolic/genetic disease with infantile brain atrophy
± phenytoin
Metastases (diffuse sclerotic)
Microcephaly
Chronic anemias
Often asymptomatic
Patients with skull base ST
Look for foraminal/canal overgrowth/encroachment
May cause cranial neuropathy
In many cases, evaluation of underlying brain can help to establish diagnosis
Many tests can help discriminate among etiologies
Skull findings often harbinger of underlying disease
Therapy aimed at treating underlying etiology
What could be underlying clinical cause of ST?
Normal variant (most common)
Other: Metastases, anemia, parathyroid disorder, etc.
Skull thickening (ST), calvarial thickening
Diploic space expansion ± adjacent cortical thickening
Best diagnostic clue
Diffuse/focal increased skull width; variable size
Location
Any bone can be involved; calvaria > skull base > occipital squamae
Morphology
Generalized, regional or focal, depending on etiology
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