Copper beaten skull, also known as beaten silver skull or beaten brass skull, refers to the prominence of convolutional markings (gyral impressions on the inner table of the skull) seen throughout the skull vault.
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Clinical presentation
There are no clinical features specific and unique to a copper-beaten skull, as the osseous features are on the skull's inner surface. The appearance may be associated with skull abnormalities (e.g. craniosynostosis) and raised intracranial pressure in children; the clinical presentation may reflect these underlying causes.
It is important to note that a copper-beaten appearance can be seen in normal children during periods of rapid brain growth between 2-3 and 5-7 years 5.
Pathology
Raised intracranial pressure was once thought to be the single causative mechanism behind increased inner table markings that give rise to the copper-beaten skull appearance. However, this appearance is not specific, and other causes include:
Importantly, although the degree of prominance of copper beaten appearance may correlate with higher raised intracranial pressure it should not be used to estimate or exclude abnormalities of intracranial pressure 5.
Radiographic features
Rather than the inner table of the skull being smooth, there are convolutions that overlie the gyri. As described above (and seen in the differential diagnosis case), convolutional changes may be normal if they are confined to the posterior calvaria and are subtle.
3D volume-rendered reformats demonstrate a calvaria with similar appearances to hand-beaten copper pot bottoms.
Differential diagnosis
On imaging consider:
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