Head size

Question 1

What is Microcephaly?

Answer 1

An occipital-frontal circumference < 2nd centile

Question 2

What are the pathological causes of microcephaly?

Answer 2

• congenital infection
• perinatal brain injury e.g. hypoxic ischaemic encephalopathy
• fetal alcohol syndrome
• syndromes: Patau

Question 3

What are the other possible causes of microcephaly?

Answer 3

• normal variation e.g. small child with small head
• familial e.g. parents with small head
• craniosynostosis

Question 4

What is Craniosynostosis?

Answer 4

Premature fusion of skull bones

skull sutures close prematurely.

Question 5

What can happen if craniosynostosis is left untreated?

Answer 5

It will lead to raised intracranial pressure

Question 6

What are the symptoms that can present with raised ICP?

Answer 6

Developmental delay 
Cognitive impairment
Vomiting
Irritability
Visual impairment
Neurological symptoms 
Seizures.

Question 7

What are the other presenting features of Craniosynostosis?

Answer 7

• Anterior fontanelle closure before 1 year of age

* Small head in proportion to the body

Question 8

What is the first line investigation for

Answer 8

Skull x-ray

Question 9

What is used to confirm the diagnosis of

Answer 9

CT head with bone views

Question 10

What is the management of mild cases of Craniosynostosis?

Answer 10

monitored and followed up over time.

Question 11

What is the management of more severe cases of Craniosynostosis?

Answer 11

More severe cases require surgery for surgical reconstruction of the skull.

Question 12

What is the prognosis of Craniosynostosis?

Answer 12

Good with proper management.

They will have a lifelong scar on the scalp where the surgery was performed.

Question 13

What are the different types of Synostosis?

Answer 13

Saggital Synostosis
Coronal Synostosis
Metopic Synostosis
Lambdoid Synostosis

Question 14

What are the features of saggital Synostosis?

Answer 14

Affects the Saggital suture

Long and narrow from front to back

Question 15

What are the features of Coronal Synostosis?

Answer 15

Coronal suture

Bulging on one side of the forehead

Question 16

What are the features of Metopic Synostosis?

Answer 16

Metopic suture
Pointy triangular forehead
Lambdoid Synostosis Lambdoid suture Flattening on one side of the occiput

Question 17

What are the features of Lambdoid Synostosis?

Answer 17

Lambdoid suture

Flattening on one side of the occiput

Question 18

What is Plagiocephaly?

Answer 18

Flattening of one area of the baby’s head.

Question 19

What is Brachycephaly?

Answer 19

Flattening at the back of the head, resulting in a short head from back to front.

Question 20

Why do Plagiocephaly and Brachycephaly occur?

Answer 20

The baby had a tendency to rest their head on a particular point, resulting in the skull bones and sutures moulding with gravity to create an abnormal head shape.

Question 21

When do tend to occur?

Answer 21

Baby aged 3 – 6 months

Question 22

Why do brachycephaly and and Plagiocephaly occur?

Answer 22

Baby had a tendency to rest their head on a particular point, resulting in the skull bones and sutures moulding with gravity to create an abnormal head shape.

Question 23

What do patients with brachycephaly and Plagiocephaly tend to have a history of?

Answer 23

Preferring to sleep on one side of their head.

Question 24

What is important to exclude immediately?

Answer 24

Craniosynostosis

Question 25

What are some simple measures can be taken to encourage the baby to avoid resting on the flattened area

Answer 25

• Positioning them on the rounded side for sleep
• Supervised tummy time
• Using rolled towels or other props
• Minimising time in pushchairs and car seats