Is cutis verticis Gyrata-Intellectual Disability syndrome an underdiagnosed condition? A case report and review of 62 cases

A Rare Case of Neuropathic Pain in Cutis Verticis Gyrata: A Review of Contemporary Literature

Cutis verticis gyrata (CVG) is a rare benign neurocutaneous condition marked by thickened scalp folds resembling cerebral gyri and sulci. It has been classified into primary essential, primary non-essential, and secondary types. The primary essential type is idiopathic, and the primary non-essential type may be associated with neurological or ophthalmological complications. Secondary CVG occurs more commonly than primary CVG, affects both genders at any age, and can be associated with endocrinal disorders, tumors, inflammatory diseases, or genetic conditions. For every 38.46 male cases, only one female case is known. This report aims to inform about a rare case of primary CVG in a 35-year-old female patient presenting with neuropathic pain localized to the affected area, a complication not previously documented in the literature. Heightened sensitivity to light touch and pinprick sensation in the high parietal scalp region was indicative of neuropathic pain. This report also highlights the importance of a multidisciplinary approach to treatment, including pharmacological treatment modalities such as analgesics and non-pharmacological management such as desensitization techniques and physical therapy. Critically, it is necessary to regularly follow up and perform proper clinical evaluation and screening to improve the quality of life for patients with CVG.

Localized Congenital Cutis Verticis Gyrate with Skull Erosion

Localized congenital cutis verticis gyrate (CVG) is rare and potentially risks skull involvement. A 23-year-old woman presented with a congenital scalp mass in the occipital region. Local thickening of her left occipital scalp with ridges and furrows was observed on examination. Head computed tomography scan showed a lytic area underneath the same area of the occipital calvarium. The mass was surgically removed due to the skull erosion and cosmetic reasons. Pathologic evaluation established CVG. Surgical excision is best for localized congenital CVG with skull erosion due to cosmetic reasons. Surgical excision was rewarding to the patient it allowed her to style her hair.

Primary Essential Cutis Verticis Gyrata: A Case Report

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Dynamic evolution of a scalp congenital melanocytic nevus with poliosis and cutis verticis gyrata

Cutis verticis gyrata (CVG), characterized by cerebriform overgrowth of the scalp, is rarely observed in congenital melanocytic nevi (CMN). We describe a 13-year-old male with autism and a large CMN of the scalp with numerous satellite nevi whose scalp nevus exhibited evolution with poliosis and CVG. Given the potential association of CVG (independent of CMN) with seizures, neuropsychiatric, and ophthalmologic disorders, and nevus-associated CVG (cerebriform intradermal nevus) with melanoma, multidisciplinary evaluation of CMN patients with CVG is important to guide management and treatment.

Acromegaly-related cutis verticis gyrata

OBJECTIVE

Acromegaly is a disorder caused by hypersecretion of growth hormone (GH), resulting in excessive levels of insulin-like growth factor 1 (IGF-1), and almost always due to a pituitary tumor. It is classically associated with acral enlargement, prominent facial features and soft tissue overgrowth. Skin manifestations include hirsutism, acne, skin tags, oily skin and acanthosis nigricans. However, other uncommon dermatological features, such as cutis verticis gyrata (CVG), may also occur. Here, we review acromegaly-related CVG aiming to raise awareness for its possible occurrence in this setting, and we discuss its pathophysiology, presentation, management and differential diagnosis.

DESIGN

A comprehensive literature search regarding CVG, particularly CVG related to acromegaly, has been carried out. Case reports, original studies and review papers, were considered.

RESULTS

CVG is a rare benign skin lesion characterized by thickened and folded scalp, resembling the brain gyri and sulci. The diagnosis of CVG mainly relies on clinical examination, although tissue biopsy may be necessary in case of uncertain etiology. In acromegaly, CVG appears to be driven by the trophic effects of GH and IGF-1 on skin and soft tissues. While CVG is uncommon in acromegaly, it seems to occur more frequently in male patients. The management of acromegaly-related CVG essentially relies on controlling the serum levels of GH and IGF-1. Surgical skin procedures should be reserved for patients with severe aesthetic distress, after achieving the best possible control of acromegaly.

CONCLUSIONS

CVG is a rare manifestation of acromegaly that may allow an earlier diagnosis and a swifter treatment of these patients, which in turn may improve or entirely reverse such remarkable skin lesions.

Primary nonessential cutis verticis gyrata with acne keloidalis nuchae

Cutis verticis gyrata is a rare disorder characterized by redundant skin forming deep furrows and convolutions. It has been associated with several systemic and cutaneous disorders. We report a case of primary non-essential cutis verticis gyrata in association with acne keloidalis nuchae in a schizophrenic patient.

Cutis verticis gyrata: Two cases associated with drug-resistant epilepsy

Cutis verticis gyrata (CVG) is a neurocutaneous syndrome characterized by the formation of folds in the scalp that resembles the cerebral cortex. We present two cases of CVG and intellectual disability with drug-resistant epilepsy. Recognizing CVG is necessary to provide interdisciplinary support for the treatment of comorbidities associated with this entity.

Primary Essential Cutis Verticis Gyrata: A scalp condition that may appear in various disorders

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Neurosurgical and Scalp Reconstructive Challenges During Craniotomy in the Setting of Cutis Verticis Gyrata

BACKGROUND

Cutis verticis gyrata (CVG) is a rare condition of the scalp in which thickening of the dermis induces rigid folds and furrows resembling the cerebral cortex. Two forms of primary CVG exist: essential, in which CVG is the only presenting problem, and nonessential, in which the scalp condition occurs along with neuropsychiatric ailments. CVG can also occur secondary to a variety of causes including inflammatory, neoplastic, and metabolic conditions or drug use. A review of the available literature, including description of the epidemiology, pathophysiology, histology, and typical management of CVG, is provided. However, we identified no literature describing the complications of CVG in the setting of a craniotomy.

CASE REPORT

The patient presented here is a 54-year-old man with CVG who presented with occlusion of the M2/M2 branches of the middle cerebral artery, resulting in malignant cerebral edema, requiring emergent management via decompressive craniectomy. Because of the thickening of the scalp, skin incision was complicated by bleeding and difficulty in achieving hemostasis using Raney clips. Plastic surgery was consulted intraoperatively for assistance with complex closure of the wound in a multilayered fashion. Despite this, the patient's postoperative course was complicated by cerebrospinal fluid leakage due to difficulty in approximating the incision during closure. Subsequent cranioplasty was performed jointly between neurosurgery and plastic surgery.

CONCLUSIONS

Despite its rarity, CVG is an important issue for neurosurgeons to understand as it can present complications in performing craniotomy, most notably during the scalp exposure and closure. CVG may also complicate the postoperative course if adequate approximation of the tissues cannot be achieved, resulting in wound infection and/or cerebrospinal fluid leak. The presented patient benefited from a combined neurosurgical and plastic surgical approach that was implemented intraoperatively and continued through the postoperative stages and the subsequent cranioplasty.

Idiopathic Cutis Verticis Gyrata in a Female

Cutis verticis gyrata (CVG) is a benign proliferation and hypertrophy involving the scalp which exhibits furrows resembling the cerebral cortex convolutions. The diagnosis of CVG is based on clinical findings. Complementary investigations are recommended to rule out local or systemic underlying disorders. Idiopathic or essential primary CVG refers to cases without obvious origin and with no other associated abnormalities. These forms affect mainly men. Herein, the authors present a new observation of an idiopathic CVG in a female, which seems to be extremely rare.