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HYPEROSTOSIS FRONTALIS INTERNA

1956; BMJ; Volume: 19; Issue: 1 Linguagem: Inglês

10.1136/jnnp.19.1.42

1468-330X

Sadie E. Smith, R. E. Hemphill,

Restraint-Related Deaths

It was in 1765 that Morgagni first described the triad of hyperostosis frontalis interna, obesity, and virilism.More than 150 years later Stewart (1928) and Morel (1930), on examining hyperostosis frontalis interna in psychiatric cases, suggested that the combination of hyperostosis and endocrine and neuropsychiatric disturbances was a definite syn- drome.This came to be called the Morgagni, or Morgagni-Stewart-Morel, syndrome.Hyperostosis, discovered at necropsy or radiologically, is not very uncommon in psychiatric conditions, and this may have tempted many authors to assume a causal relationship, for in many papers there is no clear definition of the syndrome and the bony changes are loosely spoken of as if they constituted the syndrome itself.Grollman and Rousseau (1944) have even stated that the diagnosis could be made without x-ray confirmation of bony change.Sherwood Moore (1936b) found hyperostosis frontalis interna in 1-44% of 6,650 skulls examined radiologically, and calvarial hyperostosis of all sorts in a total of 3-48%, from which he defined a symptom complex which he referred to as " metabolic craniopathy ".Medical literature is replete with accounts of the condition, e.g., van Bogaert (1930), Fracassi andMarelli (1936), Roger (1938), Notkin (1953).Grollman and Rousseau (1944) found calvarial hyperostosis in 78 or 4-1 % of 1,620 skulls of mental patients in North Carolina.No authors have so far described a consistent or specific neuro- psychiatric picture which they found associated with hyperostosis frontalis interna in a significant number of cases.Isolated cases have been described in which cerebral atrophy has been demonstrated by pneumo-encephalography (Moore, 1944), and some authors have suggested, without very much evidence, that hyperostosis damaged the brain directly.This may occur in very rare cases.Roth (1941), who discusses this question, believes that the cranial bone changes and the psychiatric disturbances are of separate origin.