Diffuse cranial vault hyperostosis associated with long‐term antiepileptic therapy: Autopsy findings and differential diagnostic considerations
- 1Department of Anatomy, Faculty of Health Sciences, School of Medicine National and Kapodistrian University of Athens Athens Greece
- 2Department of Forensic Medicine and Toxicology, School of Medicine National and Kapodistrian University of Athens Athens Greece
- 3Department of Neurosurgery General Hospital of Nikaia‐Piraeus Nikaia Greece
Abstract
Diffuse cranial vault hyperostosis is an uncommon finding and may present a diagnostic challenge in clinical and forensic practice. We report the case of a 53‐year‐old woman with a long‐standing history of epilepsy treated with phenytoin and sodium valproate who collapsed at home suddenly and died despite resuscitative efforts. Post‐mortem examination revealed marked, symmetrical thickening of the frontal, parietal, and occipital bones, with cranial vault thickness reaching approximately 20 mm. Histological analysis demonstrated expansion of the diploë with preserved lamellar architecture and absence of marrow hyperplasia, while examination of the dura mater revealed focal fibrosis and ossification. No evidence of trauma, neoplasia, metabolic bone disease, or hematologic disorder was identified. In the absence of alternative etiologies and in the context of prolonged antiepileptic drug exposure, a medication‐related cranial remodeling process was considered the most plausible explanation, most plausibly associated with chronic phenytoin exposure. Death was attributed to recent myocardial ischemia in the setting of pneumonia and cerebral atrophy. This case underscores the importance of integrated clinicopathological correlation when evaluating unusual cranial thickening and highlights the forensic relevance of recognizing medication‐associated skeletal remodeling to avoid diagnostic misinterpretation.
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BibTeX
@article{piagkou2026diffuse,
title = {{Diffuse cranial vault hyperostosis associated with long‐term antiepileptic therapy: Autopsy findings and differential diagnostic considerations}},
author = {Maria Piagkou and Athina Tousia and George Triantafyllou and Dimitrios Vlachodimitropoulos and Samer Al Besher and Panagiotis Manolarakis‐Papadopoulos and Alexandros Samolis and Stavroula Papadodima},
journal = {Journal of Forensic Sciences},
year = {2026},
month = jul,
doi = {10.1111/1556-4029.70416},
url = {https://doi.org/10.1111/1556-4029.70416},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diffuse cranial vault hyperostosis associated with long‐term antiepileptic therapy: Autopsy findings and differential diagnostic considerations
AU - Maria Piagkou
AU - Athina Tousia
AU - George Triantafyllou
AU - Dimitrios Vlachodimitropoulos
AU - Samer Al Besher
AU - Panagiotis Manolarakis‐Papadopoulos
AU - Alexandros Samolis
AU - Stavroula Papadodima
PY - 2026
DA - 2026/07/16
JO - Journal of Forensic Sciences
DO - 10.1111/1556-4029.70416
UR - https://doi.org/10.1111/1556-4029.70416
AB - Diffuse cranial vault hyperostosis is an uncommon finding and may present a diagnostic challenge in clinical and forensic practice. We report the case of a 53‐year‐old woman with a long‐standing history of epilepsy treated with phenytoin and sodium valproate who collapsed at home suddenly and died despite resuscitative efforts. Post‐mortem examination revealed marked, symmetrical thickening of the frontal, parietal, and occipital bones, with cranial vault thickness reaching approximately 20 mm. Histological analysis demonstrated expansion of the diploë with preserved lamellar architecture and absence of marrow hyperplasia, while examination of the dura mater revealed focal fibrosis and ossification. No evidence of trauma, neoplasia, metabolic bone disease, or hematologic disorder was identified. In the absence of alternative etiologies and in the context of prolonged antiepileptic drug exposure, a medication‐related cranial remodeling process was considered the most plausible explanation, most plausibly associated with chronic phenytoin exposure. Death was attributed to recent myocardial ischemia in the setting of pneumonia and cerebral atrophy. This case underscores the importance of integrated clinicopathological correlation when evaluating unusual cranial thickening and highlights the forensic relevance of recognizing medication‐associated skeletal remodeling to avoid diagnostic misinterpretation.
SN - 0022-1198
SN - 1556-4029
ER -