Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided multi-slice spiral CT 3D reconstructed images and clinical history, the following are observed:
1. There is significant thickening of the skull, especially prominent in the posterior cranial region.
2. Mixed radiological features can be seen, including both lytic and sclerotic changes, with local disruption of the trabecular structure.
3. The skull base is also involved, showing irregular bony overgrowth and localized defect-like appearances.
4. Other cranial bones show abnormal morphology, but no clear evidence of adjacent soft tissue lesions with mass effect is observed.
5. Overall imaging reveals a “cotton wool appearance,” indicating widespread bone thickening and irregular morphological changes.

II. Potential Diagnoses

Given the imaging characteristics, the patient’s advanced age of 85, occipital headache, and seizure-like convulsions, the following differential diagnoses are considered:

1. Paget’s disease (Osteitis Deformans): This disease frequently occurs in the elderly and can present with mixed bone changes (both lytic and sclerotic) and skull thickening. The patient’s imaging findings are consistent with classic features of Paget’s disease.
2. Multiple Myeloma: Typically presents with predominantly lytic lesions, with less frequent sclerotic changes, and often involves bone destruction in other areas. Diagnosis usually requires laboratory tests such as serum protein electrophoresis and urine protein analysis for confirmation.
3. Metastatic Bone Disease: Certain cancers can exhibit mixed lytic and sclerotic lesions, but they usually occur alongside a history of malignancy or other metastatic sites. A thorough systemic evaluation and tumor marker analysis are often needed.
4. Fibrous Dysplasia (Sclerotic Type): Extremely rare and typically restricted to a limited area of the bone rather than widespread involvement. Imaging may show changes in bone structure, but the presentation here does not completely match fibrous dysplasia.

III. Final Diagnosis

Considering the patient’s age, the extent of skull thickening, the pattern of lesions (both lytic and sclerotic), and the clinical symptoms of bone pain and seizure episodes, the most likely diagnosis is: Paget’s disease (Osteitis Deformans).
Further confirmation can be achieved by checking serum alkaline phosphatase levels (especially bone-specific ALP) and other bone metabolism-related tests. A bone biopsy may be necessary if there is any doubt or to exclude other etiologies.

IV. Treatment Plan and Rehabilitation Strategy

1. Treatment Approach

• Medication: Bisphosphonates (such as alendronate, risedronate) can inhibit osteoclast activity and reduce bone resorption; calcium and vitamin D supplements may optimize bone metabolism.
• Pain Management: Depending on the severity of pain, symptomatic analgesics (e.g., NSAIDs) can be administered.
• Management of Neurological Symptoms: If the patient experiences recurrent seizures, a neurology consultation is recommended, and antiepileptic drugs should be considered for seizure control.
• Surgical Intervention: For severe bone deformities or significant nerve compression, surgical decompression or corrective operations may be needed. Indications should be evaluated based on overall health status, surgical tolerance, and risk-benefit analysis.

2. Rehabilitation and Exercise Prescription

Given the patient’s age-related bone changes and physical condition, an individualized, gradual exercise program is recommended, with emphasis on safety and maintaining function:

• Early Phase (Initial Recovery Stage):
  • Exercise Types: Simple active limb movements while seated or lying down (e.g., ankle pumps, gentle leg lifts).
  • Exercise Frequency: 1-2 times per day, 5-10 minutes each session.
  • Exercise Intensity: Low intensity to avoid fatigue; closely monitor pain or fatigue.
• Mid Phase (After Adaptation):
  • Exercise Types: Light strength training (e.g., low-resistance elastic band exercises) and flexibility exercises.
  • Exercise Frequency: 3-4 times per week, 15-20 minutes each session.
  • Exercise Intensity: Low to moderate intensity, keeping heart rate and breathing within tolerable ranges, with sufficient recovery.
• Late Phase (Stable Stage):
  • Exercise Types: Moderate aerobic activities (e.g., gentle flat-ground walking or water aerobics), along with maintenance of muscle strength and joint flexibility.
  • Exercise Frequency: 3-5 times per week, 20-30 minutes each session.
  • Exercise Intensity: Moderate intensity, with precautions to prevent falls and excessive loading.

Throughout rehab, regularly monitor blood pressure, heart rate, and subjective fatigue levels (RPE). If significant bone pain, dizziness, or extreme fatigue occurs, reduce the exercise intensity or pause, and consult with a rehabilitation specialist or physician.

Disclaimer

This report is based on the provided imaging and medical history for reference purposes only. It does not replace in-person consultations or professionally tailored diagnosis and treatment plans. If there are any concerns or worsening symptoms, please seek further evaluation and treatment from a specialist.