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3. PEDIATRICS > PEDIATRICS Section I: Skull and Scalp > Flashcards

PEDIATRICS Section I: Skull and Scalp Flashcards

1
Q

premature fusion of one or several of the cranial sutures.

A

Craniosynostosis

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2
Q

Besides looking like a gremlin (or a cone- headed extraterrestrial forced to live as a typical suburban human), kids with Craniosynostosis can also have these

A

increased intracranial pressure, visual impairment, and deafness.

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3
Q

Craniosynostosis:

Frontal

A

Metopic

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4
Q

Craniosynostosis:

Frontal and parietal

A

Coronal

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5
Q

Craniosynostosis:

Parietal + Occitpital

A

Lambdoid

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6
Q

Craniosynostosis:

Parietal

A

Sagittal

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7
Q

Craniosynostosis:

Front to back

A

Frontal

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8
Q

Craniosynostosis:

Lateral to medial

A

Coronal adn Lambdoid

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9
Q

Craniosynostosis:

Sagittal

A

Back to front

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10
Q

Craniosynostosis order of Fusion

A

First (2-3 monhts: Metopic
Second: Coronal
Third: Lambdoid
Fourth: Sagittal

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11
Q

Normal Suture vs Early closure apperance

A

Normal: Serrated (sawtooth)
Early Closure: More dense and sharp, eventually will disappear completely.

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12
Q

What are idiopathic types of craniosynostosis?

A

Sagittal and UNIlateral craniosynostosis

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13
Q

Eyes are close together (hypotelorism)

A

Metopic Synostosis “Trigonocephaly”

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14
Q

Ethmoid sinuses underdeveloped

A

Metopic Synostosis “Trigonocephaly”

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15
Q

“Quizzical Eye” appearance

A

Metopic Synostosis “Trigonocephaly”

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16
Q

Medial part o f the orbit slants up

A

Metopic Synostosis “Trigonocephaly”

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17
Q

Single suture synostosis most frequently associated with cognitive disorders (growth restriction of the frontal lobes)

A

Metopic Synostosis “Trigonocephaly”

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18
Q

Diagnosis

A

“Harlequin Eye” in UNILATERAL Coronal Synostisis (Brachycephaly)

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19
Q

What is the common subtype of Coronal Synostosis?

A

Unilateral Subtype

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20
Q

“Frontal Bossing”

A

Unilateral Coronaral Synostosis (Brachycephaly)

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21
Q

Tall Cranium

A

Lambdoid (turricephaly)

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22
Q

Least common craniosynostosis

A

Lambdoid (Turricephaly)

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23
Q

Most common Craniosynostosis

A

Sagittal (Scaphocephaly/Doichocephaly)

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24
Q

Long, Narrow Head.
Looks like an upside-down boat.
Usually the kids have a normal IQ
Usually the kids do NOT have hydrocephalus

A

Sagittal (Sagittal (Scaphocephaly/Doichocephaly)

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25
Q
A

SAgittal craniosynostosis

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26
Q

Associated with Marfan’s

A

Sagittal (Scaphocephaly/Doichocephaly)

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27
Q

Also referred to as Kleeblattschadel for the purpose of fucking with you

A

Clover Leaf Skull Syndrome

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28
Q

enlargement of the head with a trilobed configuration, resembling a three-leaved clover.

A

Clover Leaf Skull Syndrome

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29
Q

Clover Leaf Skull Syndrome results from premature synostotis of what sutures?

A

Coronal and Lambdoid (Most common) sutrues

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30
Q

What is the most common finding of Clover Leaf Skull Syndrome?

A

Hydrocephalus

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31
Q

Clover Leaf Skull Syndrome is associated with what disease?

A

Thanatophoric dysplasia
Apert syndrome (severe)
Crouzon syndrome (severe)

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32
Q

Most associated Syndromes of craniosynostosis?

A

Apert’s and Crouzon’s.

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33
Q

Brachycephaly (usually)
Fused Fingers (syndactyly) - “sock hand” —typically symmetrically fused hands and feet

A

Apert’s syndrome

34
Q

Brachycephaly (usually)
1st Arch structures (maxilla and mandible hypoplasia).
Hydrocephalus (more than Apert’s)
Chiari I malformations 3: ~70% of cases
Associated with patent ductus arteriosus and aortic coarctation.
Short central long bones (humerus, femur) - “rhizomelia’’

A

Crouzon’s

35
Q

What are the 7 C’s in Crouzon’s?

A

Coronal sutures fused,
Can’t Chew (1st arch structures),
Chiari I, Coarctation,
hydroCephalus,
Central bones short (rhizomelia).
Crazy eyes (exopthalmos).

36
Q

If you see them along the more anterior skull then you should think about what?

A

“Copper beaten skull” from the increased intracranial pressure.

37
Q

Diagnosis?

Give conditions that can cause this.

A

Copper beaten skull

Classic exampes:
Craniosynostosis
Obstructive hydrocephalus

38
Q

Diagnosis?

A

Luckenschadel - “Lacunar”

39
Q

Oval, round, and finger shaped defects (craters) within the inner surface of the skull. Most prominent in parietal bones.

A

Luckenschadel - “Lacunar”

40
Q

How is Luckenschadel different from Copper beaten skull?

A

Different than Copper Beaten in that:
(A) They aren’t gyriform.
(B) They aren’t related to increased ICP.
(C) They are usually present at birth.

41
Q

Skull markings associated with hydrocephalus

A

Copper beaten skull

42
Q

What’s the cause of Luckenshadel?

A

Defective bone matrix

43
Q

Luckenshadel is associated with what conditions?

A

Classic Association:
* Cliiari II malformation /Neural Tube Defects.

44
Q

What are the common conditions presenting with Lytic Skull lesions?

A

LCH, Infection, Mets, Epidermoid Cysts, Leptomeningeal Cysts,

LCH and Leptomeningeal cysts are common

45
Q

Too many fucking dendritic cells - with local invasion. It is a sorta pseudo mahgnancy thing.

A

LCH (Langerhans Cell Histiocytosis)

46
Q

beveled hole in the skull.

A

LCH (Langerhans Cell Histiocytosis)

47
Q

Diagnosis

A

LCH (Langerhans Cell Histiocytosis)

48
Q

What is the most common bone invovled in LCH

49
Q

Describe the LCH (Langerhans Cell Histiocytosis) bone lesion

A

Pure lytic (No sclerotic border)
Beveled look favirs the inner table

50
Q

What is this?

A

Button sequestrum

51
Q

If you see lytic skull lesions in a kid with neuroblastoma, what do you thick about?

A

Metastasis

52
Q

Diagnosis?

Cause?

A

These paired, mostly round, defects in the parietal bones represent benign congenital defects.

The underlying cause is a delayed or incomplete ossification in the underlying parietal bones.

53
Q

Diagnosis?

Describe

A

Wormian bones

Extra squiggles around the lambdoid sutures. “Intrasutural Bones” they call them.

54
Q

When you say, Wormian bones thick of?

A

<10 = Idiopathic
> 10 = First think Osteogenesis Imperfecta
> 10 + Absent Clavicle = Cleidocranial

55
Q

Differentials of Wormian bones?

A

PORK CHOP

Pyknodysostosis
Osteogenesis Imperfecta
Rickets
Kinky Hair Syndrome(Menke s /Fucked Copper Metabolism)

Cleidocranial Dysostosis
Hypothyroidism / Hypophosphatasia
O ne too many 21st chromosomes (Downs)
Primary Acro-osteolysis (Hajdu-Cheney)

56
Q

These conditions occure from the congenital misplacement of cells from the scalp into the bony calvarium.

A

Dermoid / Epidermoid of the Skull

57
Q

Diagnosis?

A

SKull epidermoid

58
Q

Most common location of skull epidermoid?

A

Parietal Region is Most Common
( “behind the ears ”)

59
Q

Most common location of skull Dermoid?

A

Tend to be midline. The skin ones tend to be around the orbits.

60
Q

Skull dermoid is associated with what condition when midline?

A

Ecephaloceles

61
Q

CT/MRI appearance of Skull Epidermoid vs Dermoid

A

Epidermoid:
CT: CSF
MRI: T1 Variable T2 Bright - Enhancment

Dermoid:
CT: Heterogeneous/ + Calcs
MRI: T1/T2 Bright + Wall enhancment

62
Q

This is a fracture along / involving the suture.

A

DIastatic Fracture

63
Q

Most common location of diastatic fracture

64
Q

How does one know there is traumatic injury to a suture ?

A

lassically, it will widen. This is most likely to be shown in the axial or coronal plane so you can appreciate the asymmetry ( > 1 mm asymmetry relative to the other side).

65
Q

This is a fracture with inward displacement of the bone.

A

Depressed fracture

66
Q

This is actually another subtype of depressed fracture but is unique in that it is a greenstick or “buckle” type of fracture.

A

Pingpong fracture

67
Q

Diagnsosis?

A

Pingpong fracture

68
Q

A fracture that typically has a favorable / benign clinical outcome (depressed fractures have high morbidity).

69
Q

occur in the setting of birth trauma (Mom’s pelvic bones +/- forceps).

70
Q

Indication for surgery in Depressed Fx

A

> 5 mm depression of fragments
Epdirual bleed
Superinfection
Form
function

71
Q

“Growing Skull fracture”

A

Leptomeningeal Cyst

72
Q

Diagnosis?

A

Leptomeningeal Cyst

73
Q

PAthogenesis of Leptomenigeal Cyst

A

Step 1; You fracture your noggin, AND tear the underlying dura.
Step 2: Leptomeninges herniate through the tom dura intoo the fracture site.
Step 3: Over time (a few months) CSF pulsations progressively widen the fracture site and prohibit normal healing.
Step 4: You know you shouldn’t, but you just can’t resist the urge to poke your own brain through the now cavernous cranial defect.
Initial ^ Film
Step 5: The poking triggers a powerful hallucinogenic experience. You have a telepathic conversation with a room filled with self-transforming elf machines.
You are overwhelmed with tremendous curiosity about exactly
what/who they are, and what they might be trying to show you.
Step 6: You develop epilepsy from poking your brain too much. Or was it not enough? - you can’t remember

74
Q

A rare disorder that can be shown as a focal skull defect with an associated vascular malformation.

A

Sinus Pericranii

75
Q

Diagnosis?

PAthology?

A

Sinus Pericranii

The underlying pathology is a low flow vascular malformation - which is a communication between a dural venous sinus (usually the superior sagittal) and an extra cranial venous structure via the emissary veins.

76
Q

Diagnosis

A

Sinus Pericranii

77
Q

Has a stronger associattion with Non-accidental Trauma

Subdural or Epidural?

78
Q

REtroclival HEmatoma:

Below the Tectorial membrane

A

Epidural Hematoma

79
Q

REtroclival HEmatoma:

Above the Tectorial membrane

A

Subdural Hematoma

80
Q

Chronic Subdural (CSF Density) vs Prominent CSF spaces:
Medial Displacement of Bridging Vein

A

Chronic Subdural (CSF Density)

81
Q

Chronic Subdural (CSF Density) vs Prominent CSF spaces:
Cortical veins are adjacent to the innder table

A

Prominent CSF spaces:

82
Q

Chronic Subdural (CSF Density) vs Prominent CSF spaces:

Usually Unilateral

A

Chronic Subdural

3. PEDIATRICS (32 decks)

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