Diferencia entre revisiones de «Bulging fontanelle»

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== 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  
*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  
*Dural sinus thrombosis  
*Viral syndromes
*[[Viral syndrome]]s
 
*[[Hydrocephalus]]
== 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.
==Evaluation==
*Clinical diagnosis
*Evaluate for underlying etiology
*Standard approach:
**[[Head CT]]
**[[LP]] (if not contraindicated by CT findings) with opening and closing pressures


Long SS. Transient bulging fontanelle after immunization. J Pediatr. 2005; 147(5):A3
==Management==
*Treat underlying pathology
*See [[elevated ICP]]


Opfer K. The bulging fontanelle. Lancet. 1963 Jan 12;1(7272):116.
==Disposition==


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.
==References==
<references/>


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.
[[Category:Pediatrics]]
[[Category:Symptoms]]

Revisión actual - 22:32 1 feb 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

Evaluation

  • Clinical diagnosis
  • Evaluate for underlying etiology
  • Standard approach:
    • Head CT
    • LP (if not contraindicated by CT findings) with opening and closing pressures

Management

Disposition

References

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