Paeds

Question 1

Order of cranial suture fusion

Answer 1

1. Metopic
2. Coronal
3. Lambdoid
4. Saggital

Question 2

What is metopic synostosis head shape

Answer 2

Trigonocephaly

Question 3

What is saggital synostosis head shape

Answer 3

Scaphocephaly

Question 4

What is coronal synostosis head shape

Answer 4

Brachycephaly

Question 5

What is lambdoid synostosis head shape

Answer 5

Turricephaly (if bilateral)

Question 6

“Quizzical eye appearance”

Answer 6

Metopic suture early closure
Ie Trigonocephaly

Question 7

“Harlequin eye” if unilateral

Answer 7

Early coronal suture closure
Ie Brachycephaly

Question 8

Scaphocephaly features

Answer 8

Long narrow head
Normal IQ
Usually NO hydrocephalus
Assoc with Marfans

Question 9

Turricephaly features

Answer 9

Tall cranium

Question 10

Brachycephaly features

Answer 10

Unilateral subtype more common
- causes ipsilateral orbit to elevate and contralateral frontal bone to protrude “frontal bossing”
Bilateral form rare (syndromes)

Question 11

Trigonocephaly features

Answer 11

Eyes close together (hypotelorism)
Ethmoid sinuses underdeveloped
Medial part of orbit slants up
Single suture synostosis most frequently associated with cognitive disorders (growth restriction of the frontal lobes)

Question 12

Difference between positional plagiocephaly and lambdoid craniosynostosis

Answer 12

With positional there is ipsilateral anterior ear movement
(Can have post movement with the other)

Question 13

Clover leaf skull syndrome sutures…

Answer 13

All are closed except metric and squamosal

Question 14

Kleeblattshädel is?

Answer 14

Clover leaf skull syndrome

Question 15

Clover leaf skull syndrome is characterised by

Answer 15

Enlargement of the head with a trilobed configuration

Question 16

Why do you get clover leaf skull syndrome

Answer 16

Premature synostosis of coronal and lambdoid sutures but often sagittal too

Question 17

Clover leaf skull syndrome commonly associated with

Answer 17

Hydrocephalus

Question 18

Clover leaf skull syndromic association

Answer 18

Thanatophoric dysplasia
Apert syndrome (severe)
Crouton syndrome (severe)

Question 19

Aperts syndrome

Answer 19

Brachycephaly
Fused fingers (syndactyly) - sock hand

Question 20

Crouzons syndrome

Answer 20

Brachycephaly
1st arch structures (maxilla and mandible hypoplasia)
Assoc with PDA and aortic coarctation
Short central long bones (humerus, femur) - “rhizomelia”
Chiari I malformations

Question 21

Convolutional markings to skull

Answer 21

Normal gyral impressions on inner table of skull

Question 22

Copper beaten appearance of skull

Answer 22

Same as convolutional markings but too many of them
Will be on anterior portion, not just posterior
Caused by increased ICP eg obst hydro, craniosynostosis

Question 23

Luckenschadel skull markings

Answer 23

Lacunar!
Oval round and finger shaped defects (craters) within the inner surface of the skull

Question 24

How are lacunar skull markings different to copper beaten

Answer 24

They aren’t gyriform
They aren’t related to raised ICP
They’re usually present at birth

Question 25

Why do you get lacunar skull markings

Answer 25

Defective bone matrix

Question 26

What is classic assoc of lacunar skull markings

Answer 26

Chiari II malformation

Question 27

Parietal foramina

Answer 27

Paired. Mostly round. Congenital defects in the parietal bones.

Question 28

Wormian bones

Answer 28

Extra squiggles around the lambdoid sutures >10 of them - syndrome. Think OI. >10 + absent clavicle - cleidocranial dysostosis <10 idiopathic

Question 29

Epidermoid of the skull MRI

Answer 29

T1 variable T2 bright NO enhancement

Question 30

Dermoid of the skull MRI

Answer 30

T1 bright T2 bright +/- wall enhancement

Question 31

Epidermoid of skull CT

Answer 31

CSF density

Question 32

Dermoid of the skull CT

Answer 32

More heterogenous Calcifications (internal or peripheral) may be present

Question 33

Dural communication of a Dermoid cyst requires

Answer 33

Communication through the foramen cecum- sinus tract from nose

Question 34

Caput succedaneum is

Answer 34

Subcutaneous haemorrhage Not limited by suture lines Requires no intervention Occurs due to prolonged delivery

Question 35

Subgaleal haemorrhage is

Answer 35

Deep to the aponeurosis (between aponeurosis and periosteum) NOT limited by suture lines Potentially life threatening - rapid blood loss 12-72 hrs post delivery, vacuum extraction

Question 36

Cephalohaematoma is

Answer 36

Under the periosteum Limited by suture lines Outer border may calcify as a rim No intervention usually, but can get infected (e coli) - abscess needs drained - skull OM Cause - instrumental delivery

Question 37

Diastatic fracture

Answer 37

Fracture along/involving the suture

Question 38

Ping pong fracture

Answer 38

Subtype of depressed skull fracture but is green stick or buckle type Smooth inward deformity on imaging. Can be from birth trauma

Question 39

“Growing skull fracture”

Answer 39

Leptomeningeal cyst

Question 40

Sinus pericranii

Answer 40

Focal skull defect with an associated vascular malformation Result of low flow vascular malformation

Question 41

NAI head trauma suspecions

Answer 41

Inconsistent Hx Subdural haematoma Retinal haemorrhage DAI/parenchymal contusion Cerebral oedema, stroke Depressed skull # or # crossing the suture line

Question 42

BESSI =

Answer 42

“benign enlargement of the subarachnoid space in infancy"

Question 43

BESSI is -

Answer 43

The etiology is supposed to be immature villa (that’s why you grow out of it around 2yo). Extra-axial fluid spaces arc considered enlarged if they are greater than 5 mm. The most common cause of macrocephaly,

Question 44

BESSI appearance

Answer 44

Enlarged symmetric subarachnoid spaces favouring the anterior aspect of the brain (spaces along the posterior aspect of the brain are typically normal). Brain parenchyma is normal and there is either normal ventricle size or very mild communicating hydrocephalus.

Question 45

Periventricular leukomalacia aka

Answer 45

Hypoxic-Ischemic Encephalopathy of the Newborn