In a patient with Paget disease, which finding would you notify the physician about first?

• A. Platybasia (base of skull invagination)
• B. Bowing of both legs with asymmetrical knees
• C. The patient is only 5 feet tall and weighs 120 lb
• D. The skull is soft, thick, and enlarged

Answer: (A)

The most important concept here is recognizing signs that threaten brainstem function in Paget disease and reporting them promptly. Platybasia, or base of skull invagination, signals basilar invagination with potential brainstem compression. When the skull base is deformed this way, it can rapidly impair breathing, swallowing, or level of consciousness, making it an urgent finding that must be reported to the physician right away for further imaging and neurosurgical assessment.

The other findings reflect chronic skeletal changes from Paget disease but do not by themselves indicate an immediate life-threatening complication. Bowing of the legs denotes deformity and leg pain from bone remodeling; short stature is a common consequence of the disease. A skull that is thick and enlarged is a characteristic change as well, but without neurologic symptoms it does not require the same urgent notification.