An 85-year-old woman underwent a head magnetic resonance imaging scan for evaluation of progressive gait difficulty and memory decline. Her examination findings showed marked short-term memory problems and postural instability with mild extrapyramidal signs. She had a history of chronic hypertension but no history of any endocrinopathy. She was receiving diltiazem, hydralazine, and sertraline. Blood laboratory test results showed no significant abnormalities.
Brain magnetic resonance images showed severe thickening of the inner table of the skull, with prominent bone lobulations in the frontal regions (Figure), typical of hyperostosis frontalis interna (HFI). She also had severe, diffuse small-vessel ischemic changes, most severe in the bilateral basal ganglia regions (not shown), which probably were the cause of her gait instability, extrapyramidal signs, and memory problems.
Sagittal (A) and axial (B) T1-weighted images showing severe, bilateral thickening and lobulation of the inner bone table in the frontal skull regions.
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