Symptom Finder - Forehead Enlargement
FOREHEAD ENLARGEMENT
Anatomy will help to recall the causes of forehead enlargement. Before the history and physical examination create a biased point of view, sit down and make a list of the possibilities.
1. Skin and subcutaneous tissues—Myxedema, cretinism, cellulitis, hematomas
2. Bone—Paget disease, fibrous dysplasia, leontiasis ossea, rickets, congenital syphilis, ivory exostosis, acromegaly, and metastatic carcinoma
3. Central nervous system—Hydrocephalus and meningioma
Approach to the Diagnosis
The history and physical examination will often point to the diagnosis: the nonpitting edema of hypothyroidism, the protruding jaw of acromegaly, and the disproportionate enlargement of the head compared to the facial bones in hydrocephalus. Plain films of the skull will be helpful in the diagnosis of rickets, Paget disease, acromegaly, and meningiomas. A CBC, sedimentation rate, TSH and free thyroxine (T4) index, and chemistry panel should be ordered. A neurologist should be consulted before ordering expensive diagnostic tests such as a CT scan or MRI.
Anatomy will help to recall the causes of forehead enlargement. Before the history and physical examination create a biased point of view, sit down and make a list of the possibilities.
1. Skin and subcutaneous tissues—Myxedema, cretinism, cellulitis, hematomas
2. Bone—Paget disease, fibrous dysplasia, leontiasis ossea, rickets, congenital syphilis, ivory exostosis, acromegaly, and metastatic carcinoma
3. Central nervous system—Hydrocephalus and meningioma
Approach to the Diagnosis
The history and physical examination will often point to the diagnosis: the nonpitting edema of hypothyroidism, the protruding jaw of acromegaly, and the disproportionate enlargement of the head compared to the facial bones in hydrocephalus. Plain films of the skull will be helpful in the diagnosis of rickets, Paget disease, acromegaly, and meningiomas. A CBC, sedimentation rate, TSH and free thyroxine (T4) index, and chemistry panel should be ordered. A neurologist should be consulted before ordering expensive diagnostic tests such as a CT scan or MRI.
