Abstract
This report describes a rare case of Paget's disease complicated by an intracerebral hemorrhage. The patient, a 71-year-old male, was admitted to hospital due to right hemiparesis and a sudden onset of disturbances affecting his consciousness. Computed tomography (CT) scans showed a left putaminal hemorrhage, clearly thickened calvarium, inner surface skull irregularities and a marked thickening of the skull base that showed sclerotic changes. A diffuse thickening of the calvarium is also seen in X-rays of the skull in addition to advanced basal sclerosis with platybasia. The histopathologic findings from surgically obtained specimens of the calvarium revealed trabecular thickening and what is often termed the "mosaic pattern". X-rays of the systemic bodies showed cortical enlargement and thickening, and ^<99m>Tc-HMDP bone scintigrams revealed a negative RI uptake. The serum alkaline phosphatase and urinary hydroxyproline levels were normal. Thus, based on these findings, the patient was diagnosed as having Paget's disease of the polyostotic type in the non-active phase. Hemostatic complications often occur in Paget's disease patients undergoing surgery of the skull, but few cases have been described in detail. The following conclusions have been drawn from our own surgical experience and from what has been reported in the literature:1) the location and quality of the pagetic changes should be carefully assessed because pagetic bone shows different aspects during each phase ; 2) pre-operative evaluations, such as angiographic inspection, are necessary to prevent major bleeding and, 3) attention should be paid to the complications associated with the basilar impression.
