Symptom Finder - Head Deformities
HEAD DEFORMITIES
The best method to recall the causes of head deformities is to think of the
mnemonic VINDICATE.
V—Vascular suggests Cooley anemia and the enlargement of head and cheekbones with a small bridge of the nose.
I—Infection recalls syphilis in which the head assumes the shape of a hot cross bun.
N—Neurologic disease includes microcephaly (small underdeveloped brain) and hydrocephaly (due to several causes); the most important diseases from a treatable standpoint are subdural hematomas, brain abscesses, and neoplasms. Cerebral palsy also should be included here.
D—Deficiency disease suggests rickets, in which the head is elongated, square, and flattened at the vertex.
I—Idiopathic disease recalls Paget disease. There is symmetric enlargement (occasionally a triangular shape) because the bones of the face do not enlarge. In facial hemiatrophy, one side of the head is smaller than the other.
C—Congenital disorders include scaphocephaly (elongated from front to back), oxycephaly or tower skull, hypertelorism (increased breadth of the skull and eyes far apart), mongolism, and brachycephaly.
A—Achondrodysplasia suggests a large head with a broad nose and prognathism.
T—Trauma recalls injury to the skull, causing edema (caput succedaneum), hematomas, and fractures.
E—Endocrine disorders such as acromegaly, myxedema, and cretinism cause a large head. Acromegaly is usually easily distinguishable by the protruding jaw.
Approach to the Diagnosis
Obviously, the most important thing in the workup of this symptom is a good neurologic examination and a skull x-ray film. Other studies will be dictated by the findings of the above. A blood count and morphology study will be worthwhile if Cooley anemia is suspected and Wassermann or fluorescent treponemal antibody absorption (FTA-ABS) test if congenital syphilis is suspected. Positional head deformity is most commonly caused by a child sleeping frequently in the supine position.
Other Useful Tests
1. Chemistry panel (rickets, Paget disease)
2. Serum 25-OHD and 1,25-(OH)2 D3 (vitamin D deficiency)
3. Sickle cell preparation (sickle cell anemia)
4. Bone scan (Paget disease)
5. Serum growth hormone level (acromegaly)
6. CT scan of brain (acromegaly, meningioma)
The best method to recall the causes of head deformities is to think of the
mnemonic VINDICATE.
V—Vascular suggests Cooley anemia and the enlargement of head and cheekbones with a small bridge of the nose.
I—Infection recalls syphilis in which the head assumes the shape of a hot cross bun.
N—Neurologic disease includes microcephaly (small underdeveloped brain) and hydrocephaly (due to several causes); the most important diseases from a treatable standpoint are subdural hematomas, brain abscesses, and neoplasms. Cerebral palsy also should be included here.
D—Deficiency disease suggests rickets, in which the head is elongated, square, and flattened at the vertex.
I—Idiopathic disease recalls Paget disease. There is symmetric enlargement (occasionally a triangular shape) because the bones of the face do not enlarge. In facial hemiatrophy, one side of the head is smaller than the other.
C—Congenital disorders include scaphocephaly (elongated from front to back), oxycephaly or tower skull, hypertelorism (increased breadth of the skull and eyes far apart), mongolism, and brachycephaly.
A—Achondrodysplasia suggests a large head with a broad nose and prognathism.
T—Trauma recalls injury to the skull, causing edema (caput succedaneum), hematomas, and fractures.
E—Endocrine disorders such as acromegaly, myxedema, and cretinism cause a large head. Acromegaly is usually easily distinguishable by the protruding jaw.
Approach to the Diagnosis
Obviously, the most important thing in the workup of this symptom is a good neurologic examination and a skull x-ray film. Other studies will be dictated by the findings of the above. A blood count and morphology study will be worthwhile if Cooley anemia is suspected and Wassermann or fluorescent treponemal antibody absorption (FTA-ABS) test if congenital syphilis is suspected. Positional head deformity is most commonly caused by a child sleeping frequently in the supine position.
Other Useful Tests
1. Chemistry panel (rickets, Paget disease)
2. Serum 25-OHD and 1,25-(OH)2 D3 (vitamin D deficiency)
3. Sickle cell preparation (sickle cell anemia)
4. Bone scan (Paget disease)
5. Serum growth hormone level (acromegaly)
6. CT scan of brain (acromegaly, meningioma)
