The Head

Question 1

What does a persistent posterior fontanelle with jaundice make you consider?

Answer 1

Hypothyroidism

Question 2

True or False? Neurologic complications of isolated craniosynostosis are common.

Answer 2

False. They are rare.

Question 3

Differentiate caput succedaneum from a cephalohematoma. Which will cross suture lines?

Answer 3

Caput: collection of non-pitting edematous fluid and blood in the soft tissue of the skull that accumulates over the presenting part and is due to the forces of labor. Increased incidence with prolonged labor and vacuum extraction. These typically crosses suture lines and the midline of the skull because it is ABOVE the periosteum

Cephalohematoma: collection of blood BENEATH the periosteum of the outer surface of the skull due to rupture of blood vessels located between the skull and periosteum. Most commonly over the parietal bones.

Question 4

How does subgaleal hemorrhage present?

Answer 4

Firm, fluctuant swelling over the scalp, extending posteriorly to the neck and/or in front of the ears displacing the ears laterally.

Results from the bleeding of the scalp aponeurotica.

Infant at risk fo hemorrhagic shock, hyperbilirubinemia, and.or consumptive coagulopathy due to massive blood loss. Hemophilia sometimes first presents with a subgaleal hemorrhage.

Question 5

Differentiate between linear, depressed, and basilar skull fractures.

Answer 5

Linear - uncommon, follow uncomplicated vaginal delivery/forceps. Benign, excellent prognosis. F./u xrays in 2-3 months to document healing and exclude development of leptomeningeal cyst.

Depressed - most often the result of forceps, most are unaffected neurologically and present simply with a depressed deformity in the skull. Prognosis is excellent if not neurological abnormalities.

Basilar - cause separation of occipital bone leading to DIRECT brain injury, disruption of venous structures, and significant bleeding in the posterior fossa. Poor prognosis and significant risk of permanent sequelae.

Question 6

Differentiate between subarachnoid and epidural hemorrhages.

Answer 6

Subarachnoid - can follow birth trauma or prolonged hypoxia. Minor hemorrhages are common and are usually benign. Extensive bleeding can present as seizures and/or abnormal neurologic findings. A CT or MRI will confirm diagnosis.

Epidural - arterial and venous bleeding between the bone and periosteum of the inner surface of the skull. Rare in newborn, but if present usually related to a traumatic delivery.