Article Figures & Data
Figures
- FIG 1.
Flow chart defining the process of selecting the subject inclusion cohort. EMR indicates electronic medical record.
- FIG 2.
Hyperostosis examples. Normal calvarial thickness (A). Axial bone kernel and bone window CT image with a representative example of normal calvarial thickness. Diffuse calvarial hyperostosis (B). Axial bone kernel and bone window CT image demonstrates diffuse thickening of the calvaria. Layered calvarial hyperostosis (C). Axial bone kernel and bone window CT image demonstrates calvarial thickening with discrete enlargement of the inner and outer tables (white arrows), producing a layered appearance.
- FIG 3.
Example of calvarial thickness measurements obtained in the same patient in the axial and coronal planes. Full-field (A) and zoomed (B) axial bone kernel and bone window CT images demonstrate a sample axial thickness measurement obtained 25°–35° off midline. Full-field (C) and zoomed (D) coronal bone kernel and bone window CT images demonstrate a sample coronal thickness measurement obtained 35°–45° off midline.
- FIG 4.
Development of hyperostosis in a 67-year-old man with 2 decades of waxing and waning SIH symptoms with a history of remote CSF leak at C2–C4. A, Axial CT head image at 45 years of age shows qualitatively normal calvarial thickness. B, Sagittal T1-weighted MR image at 48 years of age demonstrates severe brain sag and a suggestion of developing layered hyperostosis. Diffuse pachymeningeal thickening and enhancement are also present (not shown). C, The most recent axial head CT at 67 years of age demonstrates new layered calvarial hyperostosis.
- FIG 5.
A 53-year-old man who developed refractory papilledema and rebound intracranial hypertension following repair of a CSF-venous fistula at T8–T9 at 51 years of age. Rebound intracranial hypertension symptoms began 3 weeks following treatment. Sagittal T1-weighted (A) and axial FLAIR (B) MR images at 29 years of age demonstrate brain sag with normal baseline qualitative calvarial thickness, respectively. Sagittal T1-weighted (C) and axial T2-weighted (D) MR images at 51 years of age demonstrate improvement in brain sag with new posterior globe flattening indicative of papilledema, respectively. E, Preoperative stereotactic CT image before ventriculoperitoneal shunt placement demonstrates new layered calvarial hyperostosis.
Tables
Subject (n = 166) Control (n = 321) P Value Age (mean) (SD) 54.5 (12.8) 54.4 (12.9) .902 Male sex 63 (38.0%) 118 (36.8%) .796 CT studies 46 (27.7%) 87 (27.1%) .886 MR imaging studies 120 (72.3%) 234 (72.9%) Present Absent P Value Overall hyperostosisb n = 64
36 months (12–78)n = 102
22 months (8–49).171 Diffuse hyperostosis n = 11
36 months (7–80)n = 155
25 months (9–64).798 Layered hyperostosis n = 53
36 months(12–77)n = 113
22 months(8–51).197 a Numbers in parentheses are interquartile range (25th and 75th percentiles) of symptom duration in months.
b Diffuse and layered.
