Legend Axial FLAIR and sagittal T1-WIs demonstrate diffuse calvarial thickening. Note also the involvement of the clivus and the anterior arch of C1. Did you notice the significant basilar invagination and narrowing of the foramen magnum? If one draws a line between the posterior hard palate and the opisthion (Chamberlain's line), the tip of the dens should not extend above this line by more than 2 to 3 mm. In this case, the dens would extend above this line by several mm. Also present is probable chronic small vessel disease of the deep white matter.

 

Legend Axial CT filmed in bone windows nicely demonstrates the diffuse calvarial thickening associated with prominent bony trabeculae. Key words: calvarium

Brain Diagnosis: Paget's disease of the skull