Abnormal Head Shape
Abnormal Head Shape: Excerpt from In A Page: Pediatric Signs and Symptoms
The shape of the skull is determined by the intracranial forces, external forces, and the time of closure of the cranial sutures. Birth trauma results in cephalohematoma in 0.2–2.5% of live births, resulting in abnormal head shape and fluid or blood accumulation. Intervention for craniosynostosis may be required to relieve increased intracranial pressure or for cosmetic reasons.
Differential Diagnosis
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Caput succedaneum
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Cephalohematoma
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Plagiocephaly (flattening on one side of the head) usually positional
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Macrocephaly
–Neurofibromatosis
–Sotos syndrome
–Achondroplasia
–Robinow syndrome
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Hydrocephalus (excess cerebrospinal fluid)
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External hydrocephalus (benign extradural fluid collection)
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Microcephaly
–Autosomal dominant form
–Autosomal recessive form
–Cornelia de Lange syndrome
–Cri-du-chat syndrome
–Smith-Lemli-Opitz syndrome
–Fetal alcohol syndrome
–Congenital infection (e.g., CMV, HSV)
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Linear skull fracture
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Craniostenosis (associated syndromes)
–Crouzon syndrome
–Apert syndrome
–Ataxia-telangiectasia
–Hyperthyroidism
–Idiopathic hypercalcemia
–Mucopolysaccharidosis
–Rickets
–Sickle cell disease
–Thalassemia major
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Scaphocephaly/dolicocephaly (long, narrow head)
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Brachycephaly (broad head)
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Oxycephaly (pointed head)
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Acrocephaly (high, tower-like head)
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Trigonocephaly (triangular head)
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Clover-leaf skull
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Forehead bowing (large lateral ventricles)
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Narrow calvarium (temporal lobe agenesis)
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Small posterior fossa (cerebellar agenesis)
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Occipital bowing (Dandy-Walker malformation)
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Bitemporal widening—subdural hematoma in infancy
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Cranial meningocele
Workup and Diagnosis
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History
–Time of onset (birth vs soon after); birth trauma, including prolonged labor, instrumentation; history of intrauterine infection; family history of macrocephaly, microcephaly, genetic disorders, neurocutaneous syndromes, cranial vault abnormalities, associated limb abnormalities (syndactyly)
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Physical exam
–Visual inspection of skull, swelling, palpation of sutures for osseous ridge, pulsation, cranial bruits, abnormal transillumination
–Skin discoloration in newborns
–Signs of increased intracranial pressure
–Other findings: Skeletal dysplasia, eye abnormalities,
organomegaly, neurocutaneous signs
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Labs
–Consider genetic testing and chromosomal analysis, amino acid screen, serologies for intrauterine infection
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Studies
–Do emergently with acute change in responsiveness or decreased upgaze (“sunsetting”) sign
–X-ray of skull will show skull fractures or a band of increased bone density at prematurely closed sutures
–CT in children with craniostenosis of multiple sutures or coexisting intracranial abnormalities; also better for evaluating skull dysplasias
Treatment
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Caput succedaneum requires no therapy, and typically resolves within several days
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Cephalohematoma due to birth trauma may require transfusion if there is significant blood accumulation; may require phototherapy for secondary hemolysis and hyperbilirubinemia; needle aspiration is contraindicated because of concerns of infection
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Rapidly increasing head circumference
–May be accompanied by increased intracranial pressure, developmental delay, spasticity, and thinning of the cortical mantle
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Plagiocephaly
–Fitted shaping helmets are controversial
–Effective if used before osseous closure of sutures
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Indications for cranial vault/suture release surgery
–Relief of hydrocephalus or increased intracranial
pressure
–Improvement in the appearance of the head
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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DEPRESSION, ANXIETY, AND OTHER ABNORMAL PSYCHIC STATES (Differential Diagnosis in Primary Care)
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