Although the cause of macrocephaly is found to be benign in many cases, the large differential diagnosis includes conditions that can be life-threatening. Prompt recognition and timely diagnosis can lead to a better prognosis in many cases.
Our recent issue Emergency Department Management of Children With Macrocephaly summarizes the available literature on macrocephaly and provides recommendations for the evaluation, diagnosis, and appropriate disposition of children with macrocephaly in the acute setting.
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Here are a few key points:
- Prehospital care of the patient with macrocephaly should be focused on management of increased intracranial pressure (ICP) or seizures. Once increased ICP is identified, treatment is begun with attention to airway, breathing, and circulation.
- Thorough history and physical examination, focusing on examination of the skull and evaluation for developmental delay or neurologic deficits can help narrow the differential diagnosis of the child with macrocephaly.
- Table 2, page 8 in the issue summarizes physical examination findings associated with macrocephaly.
- Appendix 1, page 16 in the issue lists some developmental red flags, which, if present in the setting of macrocephaly, should prompt consideration of an underlying syndrome or condition.
- Head ultrasound, when available, is a good starting point for children with open fontanelles for the evaluation of hydrocephalus or tumor, but it has limited utility outside of this indication.