Hyperostosis Frontalis Interna, Causing Frontal Lobe Dysfunction and Refractory Headaches (P3.222)
Bibliographic record
Abstract
OBJECTIVE:To describe the clinical and radiological findings in a patient with hyperostosis frontalis interna (HFI) BACKGROUND:HFI is characterized by presence of multiple nodules along the inner lamina of the frontal bones. The etiology is unknown; the syndromic forms of HFI are associated with obesity and endocrine abnormalities. Non-syndromic HFI is often considered an incidental imaging finding in post menopausal women. Severe HFI, characterized by involvement of 50% or more of the frontal bones, has been associated with lobar atrophy in cadaver studies. There have been no clinical studies to confirm frontal lobe dysfunction in HFI. DESIGN/METHODS: A 67 year old woman presented with progressive memory decline and headaches noted for one year. Depressive symptoms and obsessive behavior were also reported by the family. She described multiple brief bifrontal headache episodes on daily bases. They were not associated with migraine or autonomic manifestations. The headaches proved to be refractory to multiple preventative medications and nerve blocks. She also had progressive difficulty with concentration, visual and verbal memory as well as organizational skills. RESULTS: The brain imaging studies showed massive hyperosteosis involving the frontal lobes, more prominent on the left side. She was noted to have mild renal insufficiency and horseshoe kidneys with multiple renal cysts. The neuropsychological testing confirmed significant frontal lobe dysfunction manifested as apathy and impairment in abstract reasoning, cognitive inflexibility and executive dysfunction. She also exhibited severe semantic memory issues, perseveration, impulsivity and poor sustained attention. CONCLUSIONS: Although often considered an incidental radiological finding, non-syndromic HFI may cause frontal lobe compromise due to mass effect. This may be attributable to a dynamic relationship between the size and shape of the calvarium and the brain size. We propose the combination of HFI and horseshoe kidneys may represent a syndromic form of HFI never described before in the literature. Study Supported by:
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".