Journal o f the neurological Sciences Elsevier Publishing Company, Amsterdam - Printed in The Netherlands
Short Report Positive Brain Scan in Hyperparathyroidism A Case Report INTRODUCTION
There are a number of conditions of the skull and scalp which may give positive brain scans, for example fibrous dysplasia (DiChiro 1961 ; Quinn 1964; Quinn et al. 1965 ; Wagner 1968), hyperostosis frontalis interna (Quinn 1964; Quinn et al. 1965 ; Heiser et al. 1966; Wagner 1968), Paget's disease (Quinn 1964; Heiser et al. 1966 ; Ciric et al. 1967; Wagner 1968), osteomyelitis of the calvarium (Quinn 1964; Wagner 1968), contusion or laceration of the scalp (Quinn 1964; Gilson and Gargano 1965 ; Quinn et al. 1965; Williams and Beiler 1966; Ciric et al. 1967; Wagner 1968), interdiploic venous lakes (Webber 1965), neoplasia, either primary or metastatic to the calvarium (Quinn 1964; Bollinger et al. 1965), recent craniotomy or 'burr-hole' production (Quinn 1964; Heiser et al. 1966) and apparent increased uptake secondary to contralateral ischemia of the scalp as a result of temporal artery, external or common carotid occlusion (Heiser et al. 1966). Other superficial lesions, both normal and pathological, which can cause positive brain scans have also been reported. Enlarged vein of Trolard (Quinn 1964; Quinn et al. 1965 ; Wagner 1968), pachymeningitis (Heiser et al. 1966; Williams and Beiler 1966; Ciric et al. 1967) and asymmetrical dural sinuses (Quinn 1964; Wagner 1968) are a few such. The detection of these abnormalities depends upon a relative increase in radioactivity as a result of hypervascularity (Quinn 1964; Bollinger et al. 1965). Hyperparathyroidism involving the calvarium shows just such increased vascularity as well as thickening of the calvarium and it would therefore be no surprise to discover an increased uptake of 99mTc in the presence of this abnormality. Except for a reference to increased uptake over the vascular rim in chronic renal disease secondary to poor renal clearance of the isotope (Freeman and Johnson 1969) this has not previously been reported. CASE REPORT A 22-year-old colored female was admitted to Eugene Talmadge MemorM Hospital (No. 094-241) in April 1968, on referral from her local physician who had documented acute glomerulonephritis of several months' duration. She exhibited the usual laboratory and radiographic changes of hyperparathyroidism secondary to chronic renal disease. She had subperiosteal resorption of the cortex of several phalanges, periarticular calcification at the interphalangeal joints, 'woolly osteoporosis' and thickening of the skull (Fig. 1), 'rugger jersey spine', bone cysts, resorption of the lateral ends of the clavicles and loss of the lamina dura of the teeth. The bloodurea nitrogen (BUN) was 120 mg/100 ml, serum Ca varied between 8 and 10 mg/ 100 ml; the serum P was between 4 and 9 mg/100 ml. J. neurol. Sci., 1971, 13:227-230
228
SHORT REPORT
1A
1B Fig. 1. Brain scan. A : the lateral view shows a very dense uptake of the isotope along the vault of the skull. This appears denser than the basal uptake. The concentration ha the parotid #and and nasal mucosa is normal; B: the frontal view also shows the abnormal increased uptake along the skull vault. J. neurol. Sci.,1971,13:227-230
SHORT REPORT
229
2A
2B Fig 2. A : a left lateral radiograph of the skull shows the typical bony changes of hyperparathyroidism in the vault. The lamina dura of the sella turcica is ill-defined. This is occasionally seen in hyperparathyroidism; B: follow-up lateral skull radiograph 3 months following partial removal of large hyperplastic parathyroid glands. Note the thickening and the marked sclerosis of the skull vault. J. neurol. Sci., 1971, 13:227-230
230
SHORT REPORT
While awaiting a kidney transplant, she had a grand mal seizure and developed a left hemiparesis. A brain scan with 99mTc (5 mCi) (Fig, 2) showed bilateral increased uptake of the isotope over the entire circumference of the calvarium with accentuation in the right parietal area.
DISCUSSION
The generalized increase in activity was not technical, since the uptake in the sinuses, parotid gland, and temporalis muscle areas was relatively normal. The increased uptake was considered to be secondary to the thickening and hypervascularity of the calvarium as demonstrated on the plain skull films and in a carotid angiogram. The chief differential diagnostic considerations were subdural and epidural hematoma, both on clinical grounds as well as from the appearance of the scan. The angiogram excluded these possibilities. SUMMARY
The types of lesion which may lead to an increased superficial uptake (in the calvarium) of 99mTc during a brain scan are listed. A case of hyperparathyroidism is presented and this condition is added to the list. Department of Radiology, Eugene Talmadge Memorial Hospital, Medical College of Georgia, Augusta, Ga. 30902 (U.S.A.)
T. Brooks, III ~ T. E1 Gammal W. H. Pool, Jr.
(Received 5 January, 1971) REFERENCES BOLLINGER, T. T., R. L. WITCOFSKI, J. E. WHITLEY AND C. D. MAYNARD(1965) The demonstration of extracranial neoplasms with 99mTc pertechnetate, £ nucl. Med., 6: 687-689. CIRIC, I. S., J. L. QUINN AND P. C. BucY (1967) Mercury 197 and Technetium 99m brain scans in the diagnosis of non-neoplastic intracranial lesions, J. Neurosurg., 27: 119-125. DICHmo, G. (1961) RISA encephalography and conventional neurological methods, Acta Radiol. (Stockh.) Supplement 201. FREEMAN, L. M. AND P. M. Jonsso~ (1969) Clinical Scintillation Scanning, Hoeher Medical Division, Harper and Row, New York, N.Y., p. 192. GILSON, A. J. AND F. P. GARGAND (1965) Correlation of brain scan and angiography in intracranial trauma, Amer. J. RadioL, 94: 819-827. HEISER, W. J., J. L. QUINN AND W. V. MmLLIHAN (1966) The crescent pattern of increased radioactivity in brain scanning, Radiology, 87: 483-488. QUINN, J. L. (1964) In J. L. QU1NN(Ed.), Scintillation Scanning in Clinical Medicine, Saunders, Philadelphia, Pa. QUINN, J. L., I. S. C1RtC AND W. N. HAUSER (t965) Analysis of 96 abnormal brain scans using technetium 99m (pertechnetate form), J. amer. reed. Ass., 194: 157-160. WAGNER, H. N. (1968) In H. N. WAo~m (Ed.), Principles of Nuclear Medicine, Saunders. Philadelphia. Pa. WEBBER, M. M. (1965) Technetium 99m normal brain scan and their anatomic features. Amer. £ Radiol., 94: 815-818. WILLIAM.g, J. L. AND O. BEILER (1966) Brain scanning in nontumorous conditions, Neurology.(Minneap.), 16: 1159-1166. * Present address: 549 First Street, N.W, Hickory, N.C. (U.S.A.).
J. neurol. Sci., 1971, 13:227-230

»The Leading Brain is as insightful as it is accessible. In teaching us how our brain works, we are in the advantageous position of making our brains work better. This book is a must read for anyone who is a leader, will be a leader - or even for those being led.«. Anatomy of the Brain. The brain consists of the brain stemand the cerebral hemispheres. The brain stem is divided into hind-brain, mid-brain and a ‘between-brain’ called the diencephalon. The hind-brain is an extension of the spinal cord. It contains networks of neurons that. The pdf version of this book The Leading Brain by Friederike Fabritius will be available shortly on our website. Our team will inform you by email when “The Leading Brain by Friederike Fabritius” pdf ebook available. Then you can download free pdf ebook from the link. Please join our newsletter for the latest updates about this book.

The Human Brain Book PDF was written by Rita Carter. The book was published in 2009 and is an illustrated guide that shows the readers what goes inside the most important organ of the human body: the brain. The latest edition of the book was published by DK in 2014. Rita Carter is an expert in the field of medicine and science who writer for medical publications. She has also received two awards for her services to medical journalism. This book of hers is focused solely on the structural and functional aspects of the human brain. To get the book, download The Human Brain Book Pdf for free.

The Human Brain Book Pdf Review:

The Leading Brain Pdf Free Download Pdf

Her book contains the latest research and findings from the field of neuroscience. She has incorporated brain imaging techniques UN her book for better understanding of the readers. Med students will find it helpful in learning about imaging techniques used for brain imaging. Also, there is detailed information about t

The Leading Brain PDF Free Download