Case of the month CRANIOSYNTOSIS

Contributed by

Dr. Ghulam Nabi, MD,

Pediatric Consultant and Neonatologist at Bugshan Hospital, Jeddah, Saudi Arabia (drgnabi2@gmail.com).

Patient Details:

• Full-term, male infant, born via normal vaginal delivery to a multigravida mother.
• Birth weight: 3 kg; Apgar score, vital signs, and growth parameters were normal.
• No consanguinity or antenatal issues. Normal siblings.
• Presenting complaint at 5.5 months: non-alignment of eyes.

Examination Findings:

• Alert, active infant; weight: 8.6 kg; length: 64 cm; head circumference: 39 cm.
• No visible malformations except for eye squint; referred to ophthalmologist.
• Anterior fontanel closed, unable to hold head.
• X-ray: premature closure of coronal suture, otherwise normal osseous structures.

Follow-Up:

• Regular follow-up advised.

Overview of Craniosynostosis

• Definition: Premature closure of one or more skull sutures, causing abnormal head shape and potential brain growth restriction.
• Incidence: 1 in 2000-2500 births, more common in males (3:1 ratio). 8% are syndromic or familial.
• Symptoms: Abnormally shaped head, possible increased intracranial pressure (headache, nausea, lethargy, eye movement issues).
• Diagnosis: Physical examination and diagnostic tests.
• Treatment: Surgery is recommended before 1 year old to allow for brain growth and correct deformities.
• Prognosis: Most children have good cosmetic outcomes post-surgery, although severe cases can result in neurological damage if untreated.

References

1. I.M. Mathijssen. Guideline for care of patients with craniosynostosis. Craniofacial Surg, 2015.
2. G. Tamburrini et al. Complex craniosynostosis: clinical features and management. Childs Nerv Syst, 2012.
3. G. Tamburrini et al. Intracranial pressure in craniosynostosis. Childs Nerv Syst, 2005.
4. H. Kabbani, T.S. Raguveer. Craniosynostosis. American Family Physician, 2004.
5. L. Massimi et al. Isolated sagittal craniosynostosis: classification and surgical indications. Childs Nerv Syst, 2012.