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BMJ Case Reports 2013; doi:10.1136/bcr-2013-200545

Meningeal calcification in basal cell nevus syndrome

  1. Laxmisha Chandrashekhar2
  1. 1Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
  2. 2Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and research, Pondicherry, India
  1. Correspondence to Dr Pradeep Pankajakshan Nair, drpradeeppnair17{at}gmail.com

Description

A 20-year-old woman presented with history of headache for 1 year. The headaches were mild to moderate in intensity, bilateral and non-throbbing, with no symptoms suggestive of raised intracranial pressure. The patient had hyperpigmented skin lesions for 2 years and she had undergone enucleation of odontogenic keratocyst of anterior mandible 1 year earlier (figure 1A).

Figure 1

(A) X-ray mandible showing odontogenic keratocyst, (B) hands of the patient showing multiple pits, (C) cerebral CT scan showing falx cerebri calcification and (D) cerebral CT scan showing tentorium cerebelli calcification.

On examination multiple hyperpigmented papules and few hyperpigmented plaques were seen over her face, neck, trunk, bilateral upper limbs, lower limbs and axilla. Some of them had rolled out border and central clearing. The patient's palms had multiple pits (figure 1B). Dermoscopy revealed blue grey globules, phylloid pattern, few spoke wheel areas and brown halos. An X-ray of the lumbo sacral spine showed bifid fifth Lumbar (L5) spinous process and scoliosis. The cerebral CT showed calcification of the falx cerebri (figure 1C) and tentorium cerebelli (figure 1D). The patient was diagnosed as having basal cell nevus syndrome (BCNS).1 ,2 None of her family members had similar illness.

BCNS is a rare autosomal dominant disorder with complete penetrance and variable expressivity. Kimonis et al1 have devised criteria for the diagnosis of BCNS. Cerebral calcification is a common finding in the cerebral CT scan of the patients from Indian subcontinent because of the high prevalence of tuberculosis and neurocysticercosis. However, it is prudent for a neurologist to examine the skin and the skeletal system of young patients with meningeal calcification. Indeed it is important to identify this condition early as these patients are prone to develop basal cell carcinomas and other tumours. Important aspects in the management of BCNS are frequent examination, counselling about sun protection, genetic counselling and early treatment of small tumours by surgical or non-surgical methods.

Learning points

  • Basal cell nevus syndrome is a rare autosomal dominant disorder with skin, skeletal, dental and central nervous system involvement.

  • Cerebral CT scan shows calcification of falx cerebri and tentorium cerebelli.

  • Patients are prone to develop multiple early basal cell carcinomas.

Footnotes

  • Contributors MK and DP were involved in the acquisition of data, drafting the article, final approval of the version published and MK was also involved in the conception and design. PPN was involved in the conception and design, drafting the article, revising it critically for important intellectual content, final approval of the version published. LC was involved in the acquisition of data, analysis and interpretation of data, revising it critically for important intellectual content, final approval of the version published.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

References

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