HEAD DEFORMITIES
The best method to recall the causes of head deformities is to think of the mnemonic VINDICATE.
HEAD DEFORMITIES
- 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 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 half.
- 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 exam 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 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)
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- 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.
More About Causes of Head symptoms
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HEAD MASS (Differential Diagnosis in Primary Care)
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