HEAD DEFORMITIES
The best method to recall the causes of head deformities is to think of
the mnemonic VINDICATE.
V—Vascular suggests Cooley anemia and the enlargement of head and
cheekbones with a small bridge of the nose.
I—Infection recalls syphilis in which the head assumes the shape of
a hot cross bun.
N—Neurologic disease includes microcephaly (small underdeveloped
brain) and hydrocephaly (due to several causes); the most important diseases
from a treatable standpoint are subdural hematomas, brain abscesses, and
neoplasms. Cerebral palsy also should be included here.
D—Deficiency disease suggests rickets, in which the head is
elongated, square, and flattened at the vertex.
I—Idiopathic disease recalls Paget disease. There is symmetric
enlargement (occasionally a triangular shape) because the bones of the face
do not enlarge. In facial hemiatrophy, one side of the head is smaller than
the other.
C—Congenital disorders include scaphocephaly (elongated from front
to back), oxycephaly or tower skull, hypertelorism (increased breadth of the
skull and eyes far apart), mongolism, and bradycephaly.
A—Achondrodysplasia suggests a large head with a broad nose and
prognathism.
T—Trauma recalls injury to the skull, causing edema (caput
succedaneum), hematomas, and fractures.
E—Endocrine disorders such as acromegaly, myxedema, and cretinism
cause a large head. Acromegaly is usually easily distinguishable by the
protruding jaw.
Approach to the Diagnosis
Obviously, the most important thing in the workup of this symptom is a
good neurologic examination and a skull x-ray film. Other studies will be
dictated by the findings of the above. A blood count and morphology study
will be worthwhile if Cooley anemia is suspected and Wassermann or
fluorescent treponemal antibody absorption (FTA-ABS) test if congenital
syphilis is suspected.
Other Useful Tests
-
Chemistry panel (rickets, Paget disease)
- Serum 25-OHD and 1,25-(OH)2 D3 (vitamin D deficiency)
- Sickle cell prep (sickle cell anemia)
- Bone scan (Paget disease)
- Serum growth hormone level (acromegaly)
- CT scan of brain (acromegaly, meningioma)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
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