Bulging fontanelle: Difference between revisions
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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 [[Management of Elevated Intracranial Pressure|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 [[Intracranial Hemorrhage (Main)|hemorrhage]] (spontaneous, non-accidental, or traumatic). A meticulous history and physical is essential to guide management of these infants. | |||
==Clinical Features== | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 34: | Line 35: | ||
*Viral syndromes | *Viral syndromes | ||
*Hydrocephalus | *Hydrocephalus | ||
==Evaluation== | |||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
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''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'' | ''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== | |||
</references> | |||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Symptoms]] | |||
Revision as of 22:55, 30 August 2017
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
- Meningitis
- Encephalitis
- Meningo-encephalitis
- Congestive Heart Failure
- Space-occupying lesions
- Thyroid disorders
- Intracranial Hemorrhage
- Parathyroid disorders
- Brain Abscess
- Diabetic Ketoacidosis
- Hypervitaminosis A
- Anemia
- Lead encephalopathy
- Leukemia
- Inborn errors of metabolism
- Uremia
- Trauma
- Roseola Infantum
- Vaccinations
- Shigella
- Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
- Dural sinus thrombosis
- Viral syndromes
- Hydrocephalus
Evaluation
- Clinical diagnosis
Management
Standard approach:
- Head CT followed by Lumbar Puncture if not contraindicated by CT findings
- 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
</references>