Bulging fontanelle: Difference between revisions

Latest revision as of 22:32, 1 February 2023

Background

Neonatal suture anatomy.

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:
- Head CT
- LP (if not contraindicated by CT findings) with opening and closing pressures

Management

Treat underlying pathology
See elevated ICP

Disposition

References

Authors:

@@ Line 1: / Line 1: @@
-== Pathophysiology ==
+==Background==
+[[File:Sutures from top.png|thumb|Neonatal suture anatomy.]]
+*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.
+*Meticulous history and physical is essential to guide management of these infants.
-Fontanelles are fibrous membrane-covered gaps between cranial bones. A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid. The most prominent are the anterior and posterior fontanelles
+==Clinical Features==
+*Bulging fontanelle
-A bulging fontanelle represents increased intracranial pressure, which may be transient, 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.
+==Differential Diagnosis==
+*[[Meningitis (Peds)|Meningitis]]
-*The posterior fontanelle usually closes by 1-2 months of age.
+*[[Encephalitis]]
+*Meningoencephalitis
-*The anterior fontanelle usually closes between 7-19 months of age.
+*[[Congestive Heart Failure]]
+*[[intracranial mass|Space-occupying lesions]]
-== Differential Diagnosis  ==
+*[[Thyroid]] disorders
+*[[Intracranial Hemorrhage (Main)|Intracranial Hemorrhage]]
-*Meningo-encephalitis
-*Congestive heart failure
-*Space-occupying lesions
-*Thyroid disroders
-*Intracranial hemorrhage
 *Parathyroid disorders
-*Brain abscess
+*[[Brain Abscess]]
-*Diabetic ketoacidosis
+*[[Diabetic Ketoacidosis]]
-*Intracranial hemorrhage
+*[[vitamin A toxicity|Hypervitaminosis A]]
-*Hypervitaminosis A
+*[[Anemia]]
-*Anemia
+*[[Lead Toxicity|Lead encephalopathy]]
-*Lead encephalopathy
+*[[Leukemia (Peds)|Leukemia]]
-*Leukemia
+*[[Inborn errors of metabolism]]
-*Inborn errors of metabolism
+*[[Uremia]]
-*Uremia
+*[[trauma (peds)|Trauma]]
-*Trauma
+*[[Roseola Infantum]]
-*Roseola
+*[[Vaccination Schedule|Vaccinations]]
-*Vaccinations
+*[[Shigella]]
-*Shigella
+*[[Idiopathic Intracranial Hypertension|Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)]]
-*Benign Intracranial hypertension
 *Dural sinus thrombosis
-*Viral syndromes
+*[[Viral syndrome]]s
+*[[Hydrocephalus]]
-==Treatment==
-Standard approach:
-**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)
-== Sources ==
-Baqui AH, de Francisco A, Arifeen SE, Siddique AK, Sack RB. Bulging fontanelle after supplementation with 25,000 IU of vitamin A in infancy using immunization contacts. Acta Paediatr. 1995 Aug;84(8):863-6.
-Beri S, Hussain N. Bulging fontanelle in febrile infants: lumbar puncture is mandatory. [Letter]. Arch Dis Child. 2011; 96 (1):109.
-Biswas AC, Molla MA, Al-Moslem K. A baby with bulging anterior fontanelle. Lancet. 2000; 356(9224):132.
-Long SS. Transient bulging fontanelle after immunization. J Pediatr. 2005; 147(5):A3
-Opfer K. The bulging fontanelle. Lancet. 1963 Jan 12;1(7272):116.
+==Evaluation==
+*Clinical diagnosis
+*Evaluate for underlying etiology
+*Standard approach:
+**[[Head CT]]
+**[[LP]] (if not contraindicated by CT findings) with opening and closing pressures
-Silver W, Kuskin L, Goldenberg L. Bulging anterior fontanelle. Sign of congestive heart failure in infants. Clin Pediatr (Phila). 1970 Jan;9(1):42-3.
+==Management==
+*Treat underlying pathology
+*See [[elevated ICP]]
-Shacham S, Kozer E, Bahat H, Mordish Y, Goldman M. Bulging fontanelle in febrile infants: is lumbar puncture mandatory? Arch Dis Child. 2009;94:690–692.
+==Disposition==
+==References==
+<references/>
-[[Category:Peds]]
+[[Category:Pediatrics]]
+[[Category:Symptoms]]