Bulging Fontanelle

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Background

  • Fontanelles are fibrous, membrane-covered gaps between cranial bones.
  • A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid.
    • Anterior and posterior are the most prominent
    • The posterior fontanelle usually closes by 1-2 months of age.
    • The anterior fontanelle usually closes between 7-19 months of age.
  • A bulging fontanelle represents increased intracranial pressure, which may be transient and either benign or malignant. The most commonly considered etiologies include Meningitis, space-occupying lesion, cerebral edema, and hemorrhage (spontaneous, non-accidental, or traumatic). A meticulous history and physical is essential to guide management of these infants.

Clinical Features

Differential Diagnosis

Evaluation

  • Clinical diagnosis

Management

Standard approach:

  1. Head CT followed by Lumbar Puncture if not contraindicated by CT findings
  2. Record opening and closing pressures in children is warranted

for a well appearing, asymptomatic, afebrile child with bulging fontanelle, an observation period may be appropriate. In these stable children, if a subacute condition such as an asymptomatic space-occupying lesion is likely, he may benefit from admission and MRI

Disposition

References