Question 932
{"accessible":true,"alternatives":[{"id":4694,"text":"chronically raised intracranial pressure"},{"id":4692,"text":"hyperparathyroidism"},{"id":4693,"text":"multiple myeloma"},{"id":4690,"text":"normal"},{"id":4691,"text":"Paget disease"}],"archived":false,"correctAlternativeId":4692,"explanation":"\u003cp\u003eThis is a case of secondary \u003ca href=\"/articles/hyperparathyroidism\"\u003ehyperparathyroidism\u003c/a\u003e (renal osteodystrophy) with fine radiolucencies seen throughout the skull. This is often termed the \u003ca href=\"/articles/salt-and-pepper-sign-skull-1\"\u003esalt and pepper skull\u003c/a\u003e or pepperpot skull.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003ca href=\"/articles/paget-disease-bone\"\u003ePaget\u0026nbsp;disease\u003c/a\u003e will typically cause \u003ca href=\"/articles/osteoporosis-circumscripta-cranii\"\u003eosteoporosis circumscripta\u003c/a\u003e during the early\u0026nbsp;lytic phase of the disease and then patchy sclerosis which appears fluffy (\u003ca href=\"/articles/cotton-wool-appearance-bone\"\u003ecotton wool appearance\u003c/a\u003e) later in the disease.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003eMultiple myeloma typically causes multiple larger lucent lesions to be seen within the skull. The resultant appearance is often termed\u0026nbsp;\u003ca href=\"/articles/raindrop-skull\"\u003eraindrop skull\u003c/a\u003e.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003eChronically elevated intracranial pressure can lead to the \u003ca href=\"/articles/copper-beaten-skull\"\u003ecopper beaten skull\u003c/a\u003e where gyral impressions are seen.\u0026nbsp;\u003c/p\u003e","id":932,"imageUrl":"https://prod-images-static.radiopaedia.org/images/15162234/10f9f1f6a28a511ab6d37d9d7b777df6024ade30c64a3947c828ba756eb0ec0a_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":38953},"imageAttributionCaseInfo":{"title":"Renal osteodystrophy - metabolic superscan","contributor_name":"Evan Sirc","contributor_param":"esirc","case_rid":38953,"case_param":"renal-osteodystrophy-metabolic-superscan-1"},"firstQuestionPath":"/questions/3020","nextQuestionPath":"/articles/multiple-myeloma-1/questions/901","relatedArticles":[{"id":1477,"title":"Hyperparathyroidism","link":"/articles/hyperparathyroidism?lang=us"},{"id":5972,"title":"Copper beaten skull","link":"/articles/copper-beaten-skull?lang=us"},{"id":24972,"title":"Raindrop skull","link":"/articles/raindrop-skull?lang=us"},{"id":1174,"title":"Cotton wool appearance (bone)","link":"/articles/cotton-wool-appearance-bone?lang=us"},{"id":1824,"title":"Paget disease (bone)","link":"/articles/paget-disease-bone?lang=us"},{"id":21561,"title":"Salt and pepper sign (skull)","link":"/articles/salt-and-pepper-sign-skull-1?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eWhat is the most likely cause of\u0026nbsp;this skull appearance?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/932"}],"attemptsPercentages":[{"alternativeId":"4692","percentage":53},{"alternativeId":"4693","percentage":10},{"alternativeId":"4691","percentage":33},{"alternativeId":"4690","percentage":1},{"alternativeId":"4694","percentage":4}],"promptToLogin":false,"questionManager":false,"articleId":"multiple-myeloma"}