A varied of amount of literature describes various types of falx lesions. This includes the calcification or ossification of falx which is considered to be physiological. The other end of the spectrum being pathological causes; including endocrine disorders, maroteaux type brachyolmia, hypertelorism, pseudoxanthoma elasticum, Chavany-Brunhes syndrome and Gorlin-Goltz syndrome.1,2

The falx calcification is commonest benign physiological pathology. In absence of any cause and often asymptomatic, the falx is known to show

focal calcifications, usually in the elderly.3 Rarely neoplastic lesions have been noted to occur from falx like meningioma.4 10% of geriatric population shows falx cerebri, cerebelli or tentorium cerebelli calcifications. Falcine calcifications have a characteristic dense and flat plaque like pattern.5 A laminar pattern is more common in tentorium cerebelli and along the dura.

Calcification of the falx is considered a physiological calcification. It is commonly seen in routine CT scans of brain. Considering it as a normal finding it is not mentioned in the report by many radiologists. In children calcification of the falx is a pathological condition especially when accompanied with seizures. Falx cerebri calcification is seen more commonly seen in asphyxiated babies with generalized seizures. The calcification of falx cerebri is attributed to antenatal or perinatal cerebral insult and such a calcification predisposes to generalized seizures is been proposed in a study.6 The study was conducted with the objective of analyzing the lesions of the falx from CT Brain studies conducted in our department.

Present study was prospective cross sectional observational study, conducted in department of Radio-Diagnosis, at Dr. Vitthalrao Vikhe Patil Medical College & General hospital, Ahmednagar, India. This study was conducted during the period from May 2017 to October 2018. Study was approved by institutional ethical committee.

Inclusion criteria

• All patients undergoing CT scan of brain, willing to participate in present study

Exclusion criteria

• Patient not ready to give consent and not willing to participate in the study.

Informed written consent of participating individual was taken. A pre-structured proforma was used for collection of the base line data. Computed tomography of brain was performed using a standard protocol; used in our department with GE Light speed 16 slice CT machine. CT scan was studied for the falx lesions and if present, details were noted and clinical correlation was done.

Data was collected and compiled using Microsoft Excel, analysed using SPSS 23.0 version. Statistical analysis was done using descriptive statistics.

A total of 500 patients undergoing Computed Tomography of Brain either plain or contrast were studied. The sample of 500 patients was obtained by using random sampling technique. Maximum number of patients were from 51-70 years of age group followed by 31-50 years and then 11-30 years. 59 % of male patients and 41 % of female patients were encountered in our study population.

Table 1: General characteristics

The lesions of the falx which we came across during our study included falx calcification, fatty change in the falx, combined fatty change and calcification in the falx. Most common falx lesion noticed was falx calcification (62 cases) followed by fatty change with calcification (13 cases) and then followed by fatty change in the falx (8 cases).

Table 3: The distribution of falx lesions in the study population

The lesions were described as per the location in the falx cerebri i.e. supracallosal, precallosal and retrocallosal with respect to the corpus callosum. If multiple lesions (2 or >2) were noted in the same or the other location, all the lesions were considered. Falx lesions were most commonly seen in supracallosal part (51%) followed by precallosal part (26.5 %) of falx cerebri.

Table 4: Location wise distribution of the falx lesions

Headache was associated with 54 % of patients with falx lesions as compared to 40 % of patients with no headache.

Table 5: Patients with falx lesions presenting with headache as a complaint.

The most common lesion of falx noted in the study population was calcification (14.2%) followed by fatty changes in the falx (2.6%). Falcine meningioma were least common (0.6%).

Table 6: Incidence of various falx lesions encountered in our study population

Falx cerebri and tentorium cerebelli calcifications were distributed according to the location. Supracallosal (36) being most common location in the falx cerebri calcifications followed by precallosal (23). Tentorium cerebelli calcifications were noted in 7 cases; left leaflet being more common than right.

Table 7: Distribution of falx calcification among the study population

Supracallosal (15) part of falx cerebri was the most common location in fatty falx lesions followed by precallosal (5). No fatty changes were noted in tentorium cerebelli in our study population.

Table 8: Location wise distribution of fatty changes in the falx

SAH along the falx was most commonly seen along the supracallosal location (62 %) followed by other sites.

Table 9: Location wise distribution of SAH along the falx

3 cases of falcine meningioma were seen in the study population. All the three were seen to arise from the falx cerebri. One from each part of the falx cerebri i.e. precallosal, supracallosal and retrocallosal location.

Table 10: Location wise distribution of falcine meningioma in the study population

The chi-square statistic is 0.0008. The p-value is 0.97749. This result is not significant at p < 0.05. Hence there is no correlation of occurrence of falx calcification on CT scan study with the headache of the patient in our study population.

Table 11: Correlation between falx calcification and headache.

The chi-square statistic is 3.7106. The p-value is 0.054069. This result is not significant at p < 0.05. Hence there is no correlation of occurrence of fatty falx on CT scan study with the headache of the patient in our study population.

Table 12: Correlation between fatty changes in the falx and headache.

Falx cerebri, cerebelli and tentorium cerebelli are the anatomic supportive dural folds. Headache is very common symptom encountered on day to day basis for which CT scan brain is commonly performed. Falx physiological lesions like calcification and fatty changes are also commonly seen.

Of the 500 cases studied, 94 cases (19%) showed one or another physiological or pathological lesion(s) in the falx. Hence the overall incidence of falx lesions in our study population came to be 18.8 %. The incidence of falx calcifications being most common among the study population. The incidence of falx calcification in our study population was 12 % .The incidence raised to 15% when both the cases with only falx calcification and falx calcification with adjuvant finding especially concomitant fatty changes in the falx were considered.

The incidence of 10% of falx calcification has been discussed in elderly population.5 The incidence of

the falx calcification is comparable with previously given studies however the age group has not been mentioned specifically in previous literature. In our study it was most commonly encountered in the age group of 51-70 years followed by 31-50 years consistent with the population stated in previous study i.e. elderly population. It was more common in male patients. However no correlation of gender has been mentioned in the literature with falx calcification.

The incidence of fatty changes in the falx came up to 2.6 % and fatty changes with concomitant falx calcification came up to 4.2 %. Fatty falx are been reported with the incidence of 7.3 %.7 Hence the incidence of fatty falx has been lower in our study population as compared to the study by Chen SS et al.7 This may be due to the differences in the study populations, also the study included a large sample size as compared to small sample size in the current study. It was most commonly seen in the age group of 51-70 years in our study population.

Concomitant occurrence of falx calcification and fatty falx have not been discussed separately in the literature previously. This may be due to the reason that both of them are considered as physiological findings. 1.6 % of the patients in our study showed these findings. It was seen predominantly in the 71-90 years of age group. Hence suggestive of physiological processes in elderly population.

SAH along the falx was seen in 1.6 % of the cases. Out of which 62% consisted of traumatic SAH in the age group of 31-50 years. Non-traumatic SAH was seen in 48 % cases and was more common in 51-70 years of age group. Only one case of falx calcification and SAH along the falx was seen. Although trauma related SAH was seen in young male patient, the calcification was associated with physiological process.

Falcine meningioma had an incidence of 0.6 % in the current study. Its incidence was reported to be 8.5 % in previous study.8 the male to female ratio was 1:1. It was more common in the age group of 71-90 years.

Location of falx cerebri lesions was classified into 3 anatomical parts viz precallosal, supracallosal and retrocallosal parts. The anatomical distribution and its anatomical characterization was first explained by Zimmerman et al.9 No other studies conducted in the past explain the falx lesions according to the location. In our study we distributed the lesions according to the location.

Supracallosal location followed by precallosal was the most common site for the falx lesions. Supracallosal part of falx cerebri was most commonly involved in falx calcifications, fatty falx and SAH along falx. Retrocallosal falx cerebri was least commonly involved in the lesions. No lesions were seen in the falx cerebelli in our study however, literature has mentioned physiological calcification and few lesions in the falx cerebelli as well. In case of falcine meningioma, each of 3 cases are seen in pre, supra and retrocallosal parts.

When the falx lesions were correlated with the patient’s profile, falx calcifications were associated with headache in about 38 % cases with co-morbidities associated in 57 % cases. This could be explained on the basis of the age group i.e. elderly population in which falx calcifications are common.

Fatty falx changes showed associated headache in the 25 % population and co- morbidities in 75 % 

Falx calcifications and fatty falx are considered common physiological changes in the falx. Falx though is rare site for either common or unique pathologies; and including the falx lesions may add crucial points to our reports. Falx is very common site for physiological calcifications and fatty deposits. These lesions although not having associations with patient’s symptoms may be indicative of pre-pathological conditions. Hence it is very important to mention these conditions while reporting.

Conflict of Interest: None to declare

Source of funding: Nil

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