bulging_fontanelle [Neurosurgery Wiki]

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**Bulging [[Fontanelle]]** refers to a condition where the soft spot (fontanelle) on a baby’s skull appears swollen, tense, and raised above the surrounding skull bones. It is a clinical sign that often indicates increased intracranial pressure (ICP) and requires prompt evaluation.

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### **Key Characteristics**
- **Normal Fontanelle:**
  - Soft and slightly concave.
  - Pulsations may be felt due to underlying blood flow.
- **Bulging Fontanelle:**
  - Firm and raised above the skull level.
  - May be accompanied by other symptoms such as irritability, lethargy, or vomiting.

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### **Common Causes**
1. **Increased Intracranial Pressure:**
   - **Hydrocephalus:** Excess accumulation of cerebrospinal fluid (CSF) in the brain's ventricles.
   - **Infections:**
     - Meningitis.
     - Encephalitis.
   - **Trauma:** Head injuries causing swelling or bleeding.
   - **Intracranial Hemorrhage:** Bleeding within the brain or ventricles.
2. **Infections and Inflammation:**
   - Severe systemic infections like sepsis.
   - Brain abscess or localized infections.
3. **Other Conditions:**
   - Tumors or space-occupying lesions.
   - Metabolic disorders causing swelling (e.g., hyponatremia).

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### **Associated Symptoms**
- Vomiting.
- Poor feeding.
- Lethargy or excessive sleepiness.
- Seizures.
- Irritability or high-pitched crying.
- Rapid head growth.

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### **Evaluation**
1. **Clinical Examination:**
   - Palpation of the fontanelle for bulging and tension.
   - Assessment of other signs of increased ICP.
2. **Neuroimaging:**
   - **Ultrasound (Cranial):**
     - Initial imaging for infants due to its non-invasive nature.
     - Can identify ventriculomegaly or intracranial lesions.
   - **MRI/CT:**
     - Detailed imaging to diagnose the underlying cause.
3. **Lumbar Puncture (if indicated):**
   - Evaluates CSF for infection or pressure changes, if not contraindicated by imaging findings.

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### **Management**
- **Emergency Action:**
  - A bulging fontanelle is a medical emergency if associated with severe symptoms.
  - Immediate referral to a pediatrician or neurologist.
- **Treatment Based on Cause:**
  - **Hydrocephalus:** Surgical intervention (e.g., ventriculoperitoneal shunt or endoscopic third ventriculostomy).
  - **Infections:** Antibiotics, antivirals, or other antimicrobial treatments.
  - **Trauma or Hemorrhage:** Neurosurgical intervention if needed.
  - **Tumors:** Oncological evaluation and treatment.

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### **Prognosis**
- Dependent on the underlying cause and the speed of diagnosis and treatment.
- Prompt intervention typically leads to better outcomes, especially in reversible conditions.

Let me know if you’d like further details on specific conditions or treatments!