Bulging fontanelle: Difference between revisions
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==Background== | ==Background== | ||
[[File:Sutures from top.png|thumb|Neonatal suture anatomy.]] | |||
*Fontanelles are fibrous, membrane-covered gaps between cranial bones. | *Fontanelles are fibrous, membrane-covered gaps between cranial bones. | ||
*A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid. | *A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid. | ||
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**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. | *Meticulous history and physical is essential to guide management of these infants. | ||
==Clinical Features== | ==Clinical Features== | ||
Latest revision as of 22:32, 1 February 2023
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