Hyperostosis frontalis interna presenting as depression and parkinsonism in an older woman

Abstract

Dear Editor, Hyperostosis frontalis interna (HFI) is a well-described entity from ancient times that occurs in 24% of women and 5.2% of men. 1 Although meaningful association between HFI and neurological disorders has not been proven, HFI frequently accounts for neuropsychiatric symptoms including frontal executive dysfunctions, epilepsy, cognitive impairments, parkinsonism, and frontal headache. 2-4 Here, we present an HFI case involving a woman with symptoms of depression and parkinsonism. CASE PRESENTATIONA 78-year-old woman complained of excessive fatigue, decreased rate of speech, and motor behaviours over a period of five years. As a result, she was diagnosed with Parkinson's disease and was prescribed levodopa and levodopa/carbidopa/ entacapone in outpatient neurology clinics. Because of unresponsiveness to these treatments and the nonprogressive course, the patient was referred to geropsychiatric outpatient clinics. Her physical and mental examinations revealed excessively decreased rate of speech but not poverty of speech, hypophonia, and a thought rate in the normal range without delusion. Affect was limited, decrease in facial movements, and mood was dysthymic. The patient's spontaneous attention was impaired, but her memory was intact. Bradykinesia, bilateral +2 rigidity in the upper extremities, and gait with small steps but without tremor were noted. We performed cranial magnetic resonance imaging that revealed HFI (Fig. 1).The patient was assessed in a geriatrics consultation that aimed to exclude secondary causes of Figure 1 Brain computed tomography of the patient showing left frontal thickness (12.8 mm).bs_bs_banner

Hyperostosis frontalis interna on fluorine-18 sodium fluoride PET/computed tomography of obese cancer patients: a potential mimicker of metastasis

“…Although it is frequently seen, HFI is usually underreported as it was thought to represent an anatomical variant that has no clinical significance [1,3]. Recent reports, however, suggest that HFI may be clinically relevant [3,8] and can result in severe symptoms like chronic headache and seizure [1,3,5,[9][10][11]. Symptoms of HFI can be misinterpreted and attributed to other disorders if HFI is not identified and reported [3].…”

3D‐Microarchitectural patterns of Hyperostosis frontalis interna: a micro‐computed tomography study in aged women

“…HFI is associated with cognitive slowing, mood disturbance, epilepsy, dementia, schizoaffective disorders, headache and intracranial hypertension (Hershkovitz et al 1999;Devriendt et al 2005;Djonic et al 2016). In addition there are studies that correlate HFI with Alzheimer's and Parkinson's diseases (May et al 2012;Cetiner Batun et al 2015).…”