- An 80 years old lady
- Alleged fall at home during walking
- Witnessed by daughter in-law
- After fall noted bleeding wound from left eyebrow
- No vomiting, no headache, no ear bleed, no blurred vision
- Clinical examination shows GCS 15/15, laceration at left eye brow with no active bleeding. No neurological deficit
- Vital signs are stable
- There is no hyperdense area to suggest acute intracranial haemorrhage.
- Generalised cerebral atrophy seen.
- No midline shift or mass effect. Basal cisterns are not effaced.
- There is no obvious skull vault fracture.
- Thinning of both parietal bones are seen and more prominent on the left side. This thinned bone showed no irregularity or obvious marrow changes. No soft tissue swelling overlying it.
- Scalp hematoma seen in the left frontal region measuring 1.2 cm in maximum thickness.
Diagnosis: Biparietal osteodystrophy with scalp hematoma
Discussion (Biparietal osteodystrophy)
- Biparietal osteodystrophy is bilateral thinning of the parietal bones
- It is an uncommon entity, slowly progressive acquired disease
- Exact aetiology is unknown but described as age-related bone changes in middle-aged people with slight female predilection.
- It is typically an incidental finding.