Hyperostosis frontalis interna in a patient with giant cell arteritis

Abstract

Hyperostosis frontalis interna (HFI) is a disorder characterized by progressive symmetric thickening of the inner table of the frontal bone of the human skull. HFI may be accompanied by headache and some neuropsychiatric diseases such as epilepsy and dementia. Giant cell arteritis (GCA), also called temporal arteritis, is a systemic inflammatory vasculitis of unknown etiology that affects medium- and large-sized arteries. It affects elderly people and may result in a wide variety of systemic, neurologic and ophthalmologic complications. As no association of HFI and GCA was encountered in the literature, we found it interesting to report a case with both of these clinical entities.

Frontal cortex dysfunction due to extensive hyperostosis frontalis interna

“…It was originally described as part of Morgagni-Stewart-Morel syndrome,7 (associated with virilism and obesity). Many associations have been reported since,2 8 9 but authors now agree that HFI exists independently.…”

Early hyperostosis frontalis interna found incidentally by NaF18 PET/CT bone scan

“…Our patient has no neuropsychiatric symptoms but HFI can present with non-specific symptoms such as ISSN 1925-4008 E-ISSN 1925 headache and memory loss. There is a case reported in the literature about migraine in a patient with HFI and giant cell arteritis [10] . Thus, other etiologies have to be ruled out first and radiologic imaging is needed to diagnose HFI.…”

“…This disorder can be inherited in the autosomal dominant pattern and the treatment is surgical decompression of the impaired cranial nerves [2] . HFI is associated with conditions such as frontal headaches, migraine without aura, dementia, insomnia, apathy, memory disturbance, postural instability, psychoneurosis, epilepsy, obesity, pregnancy, acromegaly, virilism, hypogonadism, hypertrichosis, hyperprolactinemia and diabetes [3,4,5] . HFI can compress the brain tissue and even lead to atrophy of the brain.…”