• Asploro Journal of Biomedical and Clinical Case Reports
• ISSN: 2582-0370
• Article Type: Clinical Image
• DOI: 10.36502/2022/ASJBCCR.6270
• Asp Biomed Clin Case Rep. 2022 Aug 03;5(2):89-90

My Head is Getting Bigger: Macrocephaly with Cause Shown on CT Head – Clinical Image

Lillian Jundi¹, Abha Sathe¹, Neuzil Lai², Forshing Lui^1*
1California Northstate University, College of Medicine, Elk Grove, California, USA
²Kaiser Permanente Medical Center, South Sacramento, Sacramento, California, USA

Corresponding Author: Forshing Lui MD ^{ORCID iD}
Address: California Northstate University, College of Medicine, 9700 West Taron Drive, Elk Grove, CA 95757, USA.
Received date: 15 July 2022; Accepted date: 27 July 2022; Published date: 03 August 2022

Citation: Jundi L, Sathe A, Lai N, Lui F. My Head is Getting Bigger: Macrocephaly with Cause Shown on CT Head – Clinical Image. Asp Biomed Clin Case Rep. 2022 Aug 03;5(2):89-90.

Copyright © 2022 Jundi L, Sathe A, Lai N, Lui F. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Macrocephaly, Big Head, Bruxism, Clinical Image

A 19-year-old man with a BMI of 23.8 kg/m² (5 ft 7 in; 152 lbs) presented with the concern of 3 years of progressively enlarging head leading to an increase in hat size. The patient fulfilled the criteria for macrocephaly as his head circumference was 62 cm, which was above the 97^th percentile for his age [1]. CT head revealed homogeneous bilateral hypertrophy of the temporalis, masseter, and medial pterygoid muscles with no evidence of a neoplastic process (Fig-1, Fig-2, and Fig-3). While genetic syndromes can be a cause of out-of-range head circumference, familial and environmental factors can contribute to variations [2,3]. In this case, the patient’s history revealed a history of bruxism since adolescence, however, no other physical or developmental abnormalities were noted. As a result, our case demonstrates bruxism and subsequent masticatory muscle hypertrophy as another possible cause of macrocephaly.

Fig-1: Bilateral Hypertrophy of Temporalis? Muscles

Fig-2: Bilateral Hypertrophy of Temporalis Muscles

Fig-3: Bilateral hypertrophy of medial pterygoid muscles

Conclusion

Acquired progressive macrocephaly caused by bruxism, as evidenced by bilateral hypertrophy of the temporalis, masseter, and medial pterygoid muscles shown on the CT head.

Acknowledgement

Informed consent has been obtained from this patient. No identifiable information about the patient will be included in this submission.

Author Contributions

Lillian Jundi participated in the literature review, drafting, and submission of the manuscript. Abha Sathe participated in the literature review, drafting, and submission of the manuscript. Neuzil Lai took care of the patient, and participated in the data collection, critical review, and submission of the manuscript. Forshing Lui helped in taking care of the patient, participated in critical review and submission of the manuscript.

Funding

This clinical image was not sponsored by any agency, and have not received any grants.

Conflict of Interest

The authors have read and approved the final version of the manuscript. The authors have no conflicts of interest to declare.

Question

With the CT head of this patient as shown in the figures, what is the cause of the abnormalities leading to progressive enlargement of his head?
A. Hydrocephalus
B. Idiopathic acquired macrocephaly
C. Overuse muscular hypertrophy due to bruxism
D. Macrocephaly caused by bilateral cavernous malformations

Correct Answer: C

References

[1] Rollins JD, Collins JS, Holden KR. United States head circumference growth reference charts: birth to 21 years. J Pediatr. 2010 Jun;156(6):907-13.e2. [PMID: 20304425]

[2] Bushby KM, Cole T, Matthews JN, Goodship JA. Centiles for adult head circumference. Arch Dis Child. 1992 Oct;67(10):1286-87. [PMID: 1444530]

[3] Weaver DD, Christian JC. Familial variation of head size and adjustment for parental head circumference. J Pediatr. 1980 Jun;96(6):990-94. [PMID: 7189556]