- 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 Lui1*
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 97th percentile for his age . 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
Acquired progressive macrocephaly caused by bruxism, as evidenced by bilateral hypertrophy of the temporalis, masseter, and medial pterygoid muscles shown on the CT head.
Informed consent has been obtained from this patient. No identifiable information about the patient will be included in this submission.
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.
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.
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?
B. Idiopathic acquired macrocephaly
C. Overuse muscular hypertrophy due to bruxism
D. Macrocephaly caused by bilateral cavernous malformations
Correct Answer: C
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 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]