Clinical Image

“Eyes at the back head,” Incidental finding of giant parietal foramina: Foramina parietalia permagna

Ibrahima NIANG1
,  
Coumba Laobé NDAO2
,  
Ndeye Bigué MAR3
,  
Sokhna BA4

1 MD, Radiology, Hospital University Fann, Dakar, Senegal

2 MD, Radiology, Hospital University Fann, Dakar, Senegal

3 MD, Anatomy Lab, University of Thies, Thies, Senegal

4 Pr, Radiology, Hospital University Fann, Dakar, Senegal

Address correspondence to:

Ibrahima NIANG

Avenue Cheikh Anta DIOP, BP 5035, Dakar,

Senegal

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Article ID: 100028A04IN2021

doi: 10.5348/100028A04IN2021CI

How to cite this article

NIANG I, NDAO CL, MAR NB, BA S. “Eyes at the back head,” Incidental finding of giant parietal foramina: Foramina parietalia permagna. Edorium J Anat Embryo 2021;8:100028A04IN2021.

ABSTRACT

No Abstract

Keywords: Foramina parietalia permagna, Parietal bone, Parietal foramina

Case Report

We report the case of a 28-year-old male patient with no specific surgical or medical history, who consulted for subacute headaches without other associated clinical signs.

A brain computed tomography (CT) scan was performed in this patient. This contrast CT scan did not reveal any cerebral, ventricular, vascular, or other cerebral lesion.

Exploration of the skull in bone window and in 3D made it possible to visualize a huge bilateral and symmetrical dilation of the parietal foramina on either side of the sagittal suture, measured at 2 × 2.5 cm to the right and 2.3 × 2.7 cm to the left, giving the appearance of “eyes at the back of the head’’ (Figure 1A) and corresponding to a foramina parietalia permagna. To highlight the extent of the dilatation, we show an image of a small parietal foramina in another patient (Figure 1B).

Figure 1: 3D view of the posterior part of the skull. (A) Our patient with huge enlargement of the parietal foramina measuring 2 × 2.5 cm to the right and 2.3 × 2.7 cm to the left. (B) Example of a slightly enlarged parietal foramina.

Discussion

“Foramina parietalia permagna,” also called “The Catlin Mark,” is a congenital anatomical variant with autosomal dominant inheritance. It is extremely rare, estimated 1 in 25,000 cases [1],[2]. Greig [3] considers it to be “sufficiently rare to make it desirable that every example be reported.”

It corresponds to a lack of ossification of the posterior membranous parietal bones during embryogenesis, leaving open parietal foramina, on each side of the sagittal suture, ranging in size from a few millimeters to approximately 2 cm.

It is most often benign, causing at most headaches and vomiting, although associations have been reported with other congenital anomalies such as cleft palate, myelomeningocele, encephaloceles, epilepsy and other defects.

Family transmission seems to be the rule, as first observed in 16 of the 56 members of the Catlin family by Goldsmith (1922) [1]. Further studies have proven the relation with heterozygous mutations of the genes ALX4 on chromosome 11 and MSX2 on chromosome 5 [4].

These bone defects could be mistaken for osteolysis, trauma (gunshot), or iatrogenic (craniotomy). They could also be useful in postmortem identification by the skull, as part of thanatoradiology or a conventional autopsy.

Conclusion

Foramina parietalia permagna is a rare congenital anatomical variant that deserves to be known and recognized, in particular by radiologists and forensic pathologists. It is most often benign but its discovery should lead to a search for other malformations that may be associated with it.

REFERENCES

1.

Goldsmith WM. “The Catlin mark” the inheritance of an unusual opening in the parietal bones. Journal of Heredity 1922;13(2):69–71. Back to citation no. 1  

2.

Griessenauer CJ, Veith P, Mortazavi MM, et al. Enlarged parietal foramina: A review of genetics, prognosis, radiology, and treatment. Childs Nerv Syst 2013;29(4):543–7. [CrossRef] [Pubmed] Back to citation no. 1  

3.

Greig DM. Congenital and symmetrical perforation of both parietal bones. J Anat Physiol 1892;26(Pt 2):187–91. [Pubmed] Back to citation no. 1  

4.

Mavrogiannis LA, Taylor IB, Davies SJ, Ramos FJ, Olivares JL, Wilkie AOM. Enlarged parietal foramina caused by mutations in the homeobox genes ALX4 and MSX2: From genotype to phenotype. Eur J Hum Genet 2006;14(2):151–8. [CrossRef] [Pubmed] Back to citation no. 1  

SUPPORTING INFORMATION

Author Contributions

Ibrahima NIANG - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published

Coumba Laobé NDAO - Acquisition of data, Interpretation of data, Drafting the article, Final approval of the version to be published

Ndeye Bigué MAR - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published

Sokhna BA - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published

Data Availability Statement

The corresponding author is the guarantor of submission.

Consent For Publication

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Competing Interests

Authors declare no conflict of interest.

Copyright

© 2021 Ibrahima NIANG et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.