Bulging fontanelle: Difference between revisions
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**The posterior fontanelle usually closes by 1-2 months of age. | **The posterior fontanelle usually closes by 1-2 months of age. | ||
**The anterior fontanelle usually closes between 7-19 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. | *A bulging fontanelle represents [[Management of Elevated Intracranial Pressure|increased intracranial pressure]], which may be transient and either benign or malignant. | ||
*Meticulous history and physical is essential to guide management of these infants. | |||
==Clinical Features== | ==Clinical Features== | ||
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*[[Meningitis (Peds)|Meningitis]] | *[[Meningitis (Peds)|Meningitis]] | ||
*[[Encephalitis]] | *[[Encephalitis]] | ||
* | *Meningoencephalitis | ||
*[[Congestive Heart Failure]] | *[[Congestive Heart Failure]] | ||
*Space-occupying lesions | *[[intracranial mass|Space-occupying lesions]] | ||
*Thyroid disorders | *[[Thyroid]] disorders | ||
*[[Intracranial Hemorrhage (Main)|Intracranial Hemorrhage]] | *[[Intracranial Hemorrhage (Main)|Intracranial Hemorrhage]] | ||
*Parathyroid disorders | *Parathyroid disorders | ||
*[[Brain Abscess]] | *[[Brain Abscess]] | ||
*[[Diabetic Ketoacidosis]] | *[[Diabetic Ketoacidosis]] | ||
*Hypervitaminosis A | *[[vitamin A toxicity|Hypervitaminosis A]] | ||
*Anemia | *[[Anemia]] | ||
*[[Lead Toxicity|Lead encephalopathy ]] | *[[Lead Toxicity|Lead encephalopathy]] | ||
*[[Leukemia (Peds)|Leukemia]] | *[[Leukemia (Peds)|Leukemia]] | ||
*Inborn errors of metabolism | *[[Inborn errors of metabolism]] | ||
*[[Uremia]] | *[[Uremia]] | ||
*Trauma | *[[trauma (peds)|Trauma]] | ||
*[[Roseola Infantum]] | *[[Roseola Infantum]] | ||
*[[Vaccination Schedule|Vaccinations]] | *[[Vaccination Schedule|Vaccinations]] | ||
*Shigella | *[[Shigella]] | ||
*[[Idiopathic Intracranial Hypertension|Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)]] | *[[Idiopathic Intracranial Hypertension|Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)]] | ||
*Dural sinus thrombosis | *Dural sinus thrombosis | ||
*Viral | *[[Viral syndrome]]s | ||
*Hydrocephalus | *[[Hydrocephalus]] | ||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
*Evaluate for underlying etiology | |||
*Standard approach: | |||
**[[Head CT]] | |||
**[[LP]] (if not contraindicated by CT findings) with opening and closing pressures | |||
==Management== | ==Management== | ||
*Treat underlying pathology | |||
*See [[elevated ICP]] | |||
==Disposition== | ==Disposition== | ||
==References== | ==References== | ||
Revision as of 00:40, 2 October 2019
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.
- Meticulous history and physical is essential to guide management of these infants.
Clinical Features
- Bulging fontanelle
Differential Diagnosis
- Meningitis
- Encephalitis
- Meningoencephalitis
- 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
- Evaluate for underlying etiology
- Standard approach:
Management
- Treat underlying pathology
- See elevated ICP