Copper-Beaten Skull Appearance as a Response of Chronically Increased Intracranial Pressure

Abstract

We present a case of 19-year-old female patient, who was injured in childhood and subsequently developed hydrocephalus, chronic elevation of intracranial pressure (ICP), and a copper-beaten skull appearance. Chronic hydrocephalus leads to an increase in intraventricular pressure, causing ventricular expansion and dislocation of adjacent cerebral structures. According to literature data, it has been hypothesized that chronically elevated ICP in persons with craniosynostosis, and other developmental structural abnormalities of the skull, may induce bone remodeling. In cases with copper-beaten skull appearance, increased ICP should be considered as a cause of death (after exclusion of all other obvious causes), and for that reason, careful examination of the skull appearance is suggested. This finding could be useful in cases with advanced postmortem changes, where it might indicate some medical conditions of the deceased or could even be considered unique feature for body identification, although this rationale should be used with great caution.

Painful papules on the dorsum of the tongue

“…Familial transmission is possible. 2 In our case, no other family members had experienced a lingual eruption. Spontaneous resolution is seen in 1 day to 3 weeks.…”

“…The restricted intracranial volume leads to chronically raised ICP, abnormal head shape and proptosed facial features, as in our patient. 1,2 Notably, the finding of convolutions on a skull radiograph may be a normal finding in young children due to the rapidly developing brain. 3 In isolation, this radiological feature is neither specific to raised ICP nor craniosynostosis.…”

A Case Report on Copper Beaten Skull Appearance: A Forgotten Entity

“…A case report by Bogdanović et al, had the typical copper beaten skull appearance due to a chronic increase in intracranial pressure following a remote head injury in a 19-year-old female patient. She was diagnosed with a case of chronic hydrocephalus which was the cause of the elevated intracranial pressure but the patient couldn't survive [ 9 ]. Whereas in another report by Ittyachen et al, the cause of the copper beaten skull couldn't be determined and was an incidental finding: a 24-year-old man with a two-week history of cough, fever and rhinitis and no history suggesting raised intracranial pressure or craniosynostosis.…”

Management of Chiari malformation in syndromic and nonsyndromic craniosynostosis

“…A beaten-copper appearance of the skull suggested elevated ICP. 4 A beaten-copper appearance is seen significantly more commonly in patients with craniosynostosis. The incidence of beaten-copper appearance increases as the child grows, suggesting that it is age dependent and evidence of long-term increased ICP.…”