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Images in Neurology
February 2005

Shrinking Brain in an Expanding Skull

Arch Neurol. 2005;62(2):326. doi:10.1001/archneur.62.2.326

We evaluated a 76-year-old woman with Paget disease who had a 5-year history of progressive memory decline secondary to a degenerative dementia, possibly Alzheimer disease. Her head magnetic resonance imaging showed moderately severe generalized cerebral and cerebellar atrophy. Also present was incidental diffuse thickening of the calvarial diploic space, with associated heterogeneous signal intensity consistent with her Paget disease. Sagittal T1-weighted (Figure, A) and axial proton density (Figure, B) magnetic resonance imaging and lateral skull x-ray film (Figure, C) results illustrating these findings are shown. Diffuse calvarial expansion with a cotton-wool appearance consistent with Paget disease was seen on the skull x-ray film (Figure, C).

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