Head Flashcards
Physical Assessment of the Head (6)
- Look for torticollis (inability to turn the head in both directions)
- Examine the head from above and side
- Examine the entire head using fingertips
- Feel for ridge over sutures
- Face
- - Forehead and upper orbit
- - Orbitonasal zygomatic area
- - Maxillomandibular area
- - Posterior cranial vault - Examine the extremities and back of child with deformation of head since congenital dislocation, scoliosis and deformed feet are more common. **
When performing the physical assessment…(3)
- When you examine head, you want to look above, from both sides, at general shape, and at the eyes
- Look at head from face on
- Look at extremities, because deformation of head could indicate problems with the spine
LOOK AT YOUR SLIDE OF THE SUTURES YOU NEED TO MEMORIZE THEM! (5)
- Metopic: frontal suture in the middle (vertical)
- Coronal: frontal horizontal suture
- Saggital suture down the middle of the head
- Lamboidal suture is in the back
- Squamosal: suture above the ears
Looking at head circumference
Check where child (
When do you measure the head?
Measure the head at 2,4,6,9,12,15,18 months,2.5,3 year old well child visits
Transilluminating the skull
can tell you how much brain is there; if there is a lot of transilluminating then there is low brain volume
*Arteriovenous malformation of brain can be indicated by bruit
Macrocephaly Head Assessment (7)
- Serial head measures
- Measure parents head
- Developmental history
- Transilluminate skull
- Look for skeletal dysplasia !
- Listen for bruit (can indicate arteriovenous malformation)
- Look for sunset eyes
- Signs of neurocutaneous disorder
Sunset eyes
when you can see sclera above the iris; can see top of the sclera; consider thyroid disease or hydrocephalus
Cafe au lait spots
Cafe au lait spots or flat round macules may indicate neurofibromitosis
Causes of microcephaly (6)
- Genetic defect
- Karyotype or axon sequencing can tell u
- Intrauterine infections
- Antenatal radiation
- Exposure to drugs and chemicals
* Certain anti-epileptics - Perinatal insult (can be due to in utero virus)
Scaphocephaly or dolichocephaly
Scaphocephaly: long, narrow head in an infant
Dolichocephaly: longer head than normal
Can be caused by positional problems in the premature infant
- Saggital Craniosynostosis
- If saggital suture closes too soon, it causes the head to grow longwise instead of outward/circular (will be a long-narrow head)
Plagiocephaly
Common with back head sleep position, torticollis;
Due to position, not premature closure; due to back-to-back sleep campaign
Craniosynostosis (5)
- Rare condition in which the skull sutures close and the bony plates of the skull become fused too early in life.
- Develops while the fetus is still in the mother’s womb
- 1 in every 2,500 births
- Sagittal suture closes prematurely
- Can occur as a part of a larger pattern of abnormalities
- Two main categories:
- - Simple or isolated craniosynostosis
- - Complex or syndromal craniosynostosis
Looking for craniosynostosis
Palpate over all sutures and feel for any overriding bones; will be normal right after birth but then they should open up
Craniosynostosis: not necessarily genetic; normal variation that occurs to cause narrow head
*But complex type could be due to one of the sutures being completely shut leading to differences in head shape
Scaphocephaly (4)
- No growth perpendicular to sagittal suture; can cause promminent occiput that is long and narrow
- Bitemporal narrowing
- Cranial elongation in anterior-posterior direction
- Characteristic: Frontal bossing and prominent occiput
Need to know what an open vs. closed suture looks like on X-ray; When a suture is open you can see a line through it
Brachycephaly (4)
- Bilateral coronal or lambdoidal (11%)
* Occurs when coronal or lamboidal suture closes prematurely; when both close you get “HIGH-HAT” apperance - Broad skull with a short base and a recessed
lower forehead. - Caused by premature closure of the coronal
suture on both sides of the head - Associated with:
- - Apert syndrome
- - Crouzon syndrome
- - Pfeiffer syndrome
Crouzon’s Syndrome (4)
- Craniosynostosis most often of the coronal and
lambdoid, and occasionally sagittal sutures - Underdeveloped midface with receded
cheekbones or exophthalmos (bulging eyes) - Ocular proptosis which is a prominence of the
eyes due to very shallow orbits.
*Inward turning iris and shallow eyes
*Very croptotic eyes; shallow orbit causing eyes to come out
*Can see high-hat - Esotropia and/or wide-set eyes.
Apert syndrome (5)
- Very high brachycephalic head
- Severe syndactyly affecting all limbs.
- Syndactyly involves bony fusion of fingers and toes
- Apert is the second most common craniofacial syndrome after Crouzon.
- Can see the brachiocephaly; high forehead, low set ears
Metopic Craniosynostosis
Causes ocular problems/fusion problems
*Doesn’t require immediate surgery
- See pointed frontal
- Palpation can indicate the overriding sutures
Oxycephaly
Closure of all sutures except squamosal; requires urgent surgery to open all the sutures
*Can cause dysmorphic features
Positional Plagiocephaly (5)
- Face will be pushed forward on the affected side
- Frontal Bossing due pressure on the occiput
- The ear on the affected side will be forward in comparison to the unaffected side
- A parallelogram will be formed.
- OCCURS BECAUSE OF A LACK OF TURNING; not a problem with sutures but a problem with positioning
Lambdoidal Craniosynostosis (3)
- If there is lambbdoidal synostosis, the head cannot expand in the frontal region on the affected side of the head so the growth will be affected on the unaffected side.
- Sincethereisgrowth restriction on the affected side, there is overgrowth everywhere else
- Atrapezoid results (leads to a trapezoid shape)
* Face is assymetrical; so one side of the face goes further out than the other
Characteristics of Crouzon’s (3)
- Multiple craniosynostoses
- Bulging or proptotic eyes
- Small eyes
Waardenburg syndrome (5)
- White forelock (white strip of hair) and beak nose
- Normal IQs
- Eyebrows are slightly bushy
- Triangular face, slightly pointed chin
- With waardenburg, it’s genetic and you develop hearing loss later in life; the amount of hearing loss varies from person to person