Bulging fontanelle - Revision history

Danbot: Add verified PubMed references (PMIDs 12825844, 16291356)

2026-03-22T10:44:41Z

Add verified PubMed references (PMIDs 12825844, 16291356)

← Older revision		Revision as of 10:44, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	[[File:Sutures from top.png\|thumb\|Neonatal suture anatomy.]]		[[File:Sutures from top.png\|thumb\|Neonatal suture anatomy.]]
	*Fontanelles are fibrous, membrane-covered gaps between cranial bones		*Fontanelles are fibrous, membrane-covered gaps between cranial bones<ref>Kiesler J, Ricer R. The abnormal fontanel. Am Fam Physician. 2003 Jun 15;67(12):2547-52. PMID 12825844</ref>
	*A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid		*A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid
	**Anterior and posterior are the most prominent		**Anterior and posterior are the most prominent
Line 7:		Line 7:
	**The anterior fontanelle usually closes between 7-19 months of age		**The anterior fontanelle usually closes between 7-19 months of age
	*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant		*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant
	*Key EM concern: [[meningitis (peds)\|meningitis]] is the most critical diagnosis to rule out in a febrile infant with a bulging fontanelle		*Key EM concern: [[meningitis (peds)\|meningitis]] is the most critical diagnosis to rule out in a febrile infant with a bulging fontanelle<ref>Freedman SB, et al. Transient bulging fontanelle after vaccination: case report and review of the vaccine adverse event reporting system. J Pediatr. 2005 Nov;147(5):640-4. PMID 16291356</ref>
	*Meticulous history and physical is essential to guide management		*Meticulous history and physical is essential to guide management

Danbot: Strip excess bold

2026-03-22T09:26:04Z

Strip excess bold

← Older revision		Revision as of 09:26, 22 March 2026
Line 7:		Line 7:
	**The anterior fontanelle usually closes between 7-19 months of age		**The anterior fontanelle usually closes between 7-19 months of age
	*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant		*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant
	*Key EM concern: ~~'''~~[[meningitis (peds)\|meningitis]]~~'''~~ is the most critical diagnosis to rule out in a febrile infant with a bulging fontanelle		*Key EM concern: [[meningitis (peds)\|meningitis]] is the most critical diagnosis to rule out in a febrile infant with a bulging fontanelle
	*Meticulous history and physical is essential to guide management		*Meticulous history and physical is essential to guide management

Line 41:		Line 41:
	===Infectious (Most Urgent)===		===Infectious (Most Urgent)===
	*'''[[Meningitis (Peds)\|Meningitis]]''' — must rule out in febrile infant		*'''[[Meningitis (Peds)\|Meningitis]]''' — must rule out in febrile infant
	*~~'''~~[[Encephalitis]]~~'''~~ / meningoencephalitis		*[[Encephalitis]] / meningoencephalitis
	*~~'''~~[[Brain abscess]]~~'''~~		*[[Brain abscess]]

	===Increased ICP===		===Increased ICP===
	*~~'''~~[[Hydrocephalus]]~~'''~~ (congenital or acquired)		*[[Hydrocephalus]] (congenital or acquired)
	*~~'''~~[[Intracranial Hemorrhage (Main)\|Intracranial hemorrhage]]~~'''~~ (traumatic or non-accidental trauma)		*[[Intracranial Hemorrhage (Main)\|Intracranial hemorrhage]] (traumatic or non-accidental trauma)
	*~~'''~~[[Intracranial mass\|Space-occupying lesions]]~~'''~~ (tumor)		*[[Intracranial mass\|Space-occupying lesions]] (tumor)
	*~~'''~~Dural sinus thrombosis~~'''~~		*Dural sinus thrombosis
	*~~'''~~[[Idiopathic Intracranial Hypertension\|Idiopathic intracranial hypertension (pseudotumor cerebri)]]~~'''~~		*[[Idiopathic Intracranial Hypertension\|Idiopathic intracranial hypertension (pseudotumor cerebri)]]

	===Metabolic/Endocrine===		===Metabolic/Endocrine===
	*~~'''~~[[Diabetic ketoacidosis]]~~'''~~		*[[Diabetic ketoacidosis]]
	*~~'''~~[[Inborn errors of metabolism]]~~'''~~		*[[Inborn errors of metabolism]]
	*Thyroid disorders (hypothyroidism)		*Thyroid disorders (hypothyroidism)
	*Parathyroid disorders (hypoparathyroidism)		*Parathyroid disorders (hypoparathyroidism)
Line 60:		Line 60:

	===Other===		===Other===
	*~~'''~~[[Leukemia (Peds)\|Leukemia]]~~'''~~ (bone marrow infiltration)		*[[Leukemia (Peds)\|Leukemia]] (bone marrow infiltration)
	*~~'''~~[[Anemia]]~~'''~~ (severe)		*[[Anemia]] (severe)
	*~~'''~~[[Lead toxicity\|Lead encephalopathy]]~~'''~~		*[[Lead toxicity\|Lead encephalopathy]]
	*~~'''~~[[Congestive Heart Failure]]~~'''~~ (with cerebral venous congestion)		*[[Congestive Heart Failure]] (with cerebral venous congestion)
	*[[Roseola infantum]] (benign, self-limited — may cause transient bulging fontanelle)		*[[Roseola infantum]] (benign, self-limited — may cause transient bulging fontanelle)
	*Post-[[Vaccination Schedule\|vaccination]] (benign, self-limited — rare)		*Post-[[Vaccination Schedule\|vaccination]] (benign, self-limited — rare)
Line 81:		Line 81:

	===Standard Approach===		===Standard Approach===
	*~~'''~~[[Head CT]]~~'''~~ (non-contrast): evaluate for hemorrhage, hydrocephalus, mass, edema		*[[Head CT]] (non-contrast): evaluate for hemorrhage, hydrocephalus, mass, edema
	**Obtain before LP if concern for mass lesion or elevated ICP		**Obtain before LP if concern for mass lesion or elevated ICP
	*'''[[LP]]''' (lumbar puncture): if not contraindicated by CT findings		*'''[[LP]]''' (lumbar puncture): if not contraindicated by CT findings
Line 87:		Line 87:
	**Send viral studies if encephalitis suspected		**Send viral studies if encephalitis suspected
	**Consider HSV PCR in neonates		**Consider HSV PCR in neonates
	*~~'''~~[[CBC]]~~'''~~, [[BMP]], blood cultures		*[[CBC]], [[BMP]], blood cultures
	*Blood glucose		*Blood glucose
	*Consider metabolic workup if no infectious or structural cause identified		*Consider metabolic workup if no infectious or structural cause identified
Line 100:		Line 100:
	==Management==		==Management==
	*Treat underlying pathology		*Treat underlying pathology
	*~~'''~~Suspected meningitis~~'''~~: empiric antibiotics should NOT be delayed for imaging or LP		*Suspected meningitis: empiric antibiotics should NOT be delayed for imaging or LP
	**<1 month: [[ampicillin]] + [[cefotaxime]] (or [[ceftriaxone]] if >28 days) +/- acyclovir		**<1 month: [[ampicillin]] + [[cefotaxime]] (or [[ceftriaxone]] if >28 days) +/- acyclovir
	**1-3 months: [[vancomycin]] + [[ceftriaxone]] (or cefotaxime)		**1-3 months: [[vancomycin]] + [[ceftriaxone]] (or cefotaxime)
	**>3 months: [[vancomycin]] + [[ceftriaxone]]		**>3 months: [[vancomycin]] + [[ceftriaxone]]
	*~~'''~~Elevated ICP~~'''~~: see [[Management of Elevated Intracranial Pressure]]		*Elevated ICP: see [[Management of Elevated Intracranial Pressure]]
	**Head of bed elevation 30 degrees		**Head of bed elevation 30 degrees
	**Neurosurgical consultation for hydrocephalus or mass		**Neurosurgical consultation for hydrocephalus or mass
	*~~'''~~Herpes encephalitis~~'''~~: IV [[acyclovir]] — start empirically in neonates with any suspicion		*Herpes encephalitis: IV [[acyclovir]] — start empirically in neonates with any suspicion
	*~~'''~~Intracranial hemorrhage~~'''~~: neurosurgical consultation, correct coagulopathy		*Intracranial hemorrhage: neurosurgical consultation, correct coagulopathy

	==Disposition==		==Disposition==

Danbot: Expanded with EM-focused content: meningitis workup, normal vs abnormal assessment, red flags, empiric antibiotic regimens, disposition

2026-03-20T23:50:55Z

Expanded with EM-focused content: meningitis workup, normal vs abnormal assessment, red flags, empiric antibiotic regimens, disposition

Show changes

Rossdonaldson1: /* Background */

2023-02-01T22:32:27Z

Background

← Older revision		Revision as of 22:32, 1 February 2023
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Sutures from top.png\|thumb\|Neonatal suture anatomy.]]
	*Fontanelles are fibrous, membrane-covered gaps between cranial bones.		*Fontanelles are fibrous, membrane-covered gaps between cranial bones.
	*A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid.		*A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid.
Line 6:		Line 7:
	**The anterior fontanelle usually closes between 7-19 months of age.		**The anterior fontanelle usually closes between 7-19 months of age.
	*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant.		*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant.
	*Meticulous history and physical is essential to guide management of these infants.		*Meticulous history and physical is essential to guide management of these infants.

	==Clinical Features==		==Clinical Features==

ClaireLewis at 00:40, 2 October 2019

2019-10-02T00:40:05Z

← Older revision		Revision as of 00:40, 2 October 2019
Line 5:		Line 5:
	**The posterior fontanelle usually closes by 1-2 months of age.		**The posterior fontanelle usually closes by 1-2 months of age.
	**The anterior fontanelle usually closes between 7-19 months of age.		**The anterior fontanelle usually closes between 7-19 months of age.
	*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant. The most commonly considered etiologies include [[Meningitis]], space-occupying lesion, cerebral edema, and [[Intracranial Hemorrhage (Main)\|hemorrhage]] (spontaneous, non-accidental, or traumatic). A meticulous history and physical is essential to guide management of these infants.		*A bulging fontanelle represents [[Management of Elevated Intracranial Pressure\|increased intracranial pressure]], which may be transient and either benign or malignant.
			*Meticulous history and physical is essential to guide management of these infants.

	==Clinical Features==		==Clinical Features==
Line 13:		Line 14:
	*[[Meningitis (Peds)\|Meningitis]]		*[[Meningitis (Peds)\|Meningitis]]
	*[[Encephalitis]]		*[[Encephalitis]]
	*~~Meningo-encephalitis~~		*Meningoencephalitis
	*[[Congestive Heart Failure]]		*[[Congestive Heart Failure]]
	*Space-occupying lesions		*[[intracranial mass\|Space-occupying lesions]]
	*Thyroid disorders		*[[Thyroid]] disorders
	*[[Intracranial Hemorrhage (Main)\|Intracranial Hemorrhage]]		*[[Intracranial Hemorrhage (Main)\|Intracranial Hemorrhage]]
	*Parathyroid disorders		*Parathyroid disorders
	*[[Brain Abscess]]		*[[Brain Abscess]]
	*[[Diabetic Ketoacidosis]]		*[[Diabetic Ketoacidosis]]
	*Hypervitaminosis A		*[[vitamin A toxicity\|Hypervitaminosis A]]
	*Anemia		*[[Anemia]]
	*[[Lead Toxicity\|Lead encephalopathy ]]		*[[Lead Toxicity\|Lead encephalopathy]]
	*[[Leukemia (Peds)\|Leukemia]]		*[[Leukemia (Peds)\|Leukemia]]
	*Inborn errors of metabolism		*[[Inborn errors of metabolism]]
	*[[Uremia]]		*[[Uremia]]
	*Trauma		*[[trauma (peds)\|Trauma]]
	*[[Roseola Infantum]]		*[[Roseola Infantum]]
	*[[Vaccination Schedule\|Vaccinations]]		*[[Vaccination Schedule\|Vaccinations]]
	*Shigella		*[[Shigella]]
	*[[Idiopathic Intracranial Hypertension\|Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)]]		*[[Idiopathic Intracranial Hypertension\|Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)]]
	*Dural sinus thrombosis		*Dural sinus thrombosis
	*Viral ~~syndromes~~		*[[Viral syndrome]]s
	*Hydrocephalus		*[[Hydrocephalus]]

	==Evaluation==		==Evaluation==
	*Clinical diagnosis		*Clinical diagnosis
			*Evaluate for underlying etiology
			*Standard approach:
			**[[Head CT]]
			**[[LP]] (if not contraindicated by CT findings) with opening and closing pressures

	==Management==		==Management==
	~~Standard approach:~~		*Treat underlying pathology
			*See [[elevated ICP]]
	~~#[[Head CT]] followed by~~ [[~~Lumbar Puncture~~]] ~~if not contraindicated by CT findings~~
	~~#Record opening and closing pressures in children is warranted~~

	''for a well appearing, asymptomatic, afebrile child with bulging fontanelle, an observation period may be appropriate. In these stable children, if a subacute condition such as an asymptomatic space-occupying lesion is likely, he may benefit from admission and MRI''

	==Disposition==		==Disposition==


	==References==		==References==

Rossdonaldson1: /* Clinical Features */

2019-04-03T04:09:35Z

Clinical Features

← Older revision		Revision as of 04:09, 3 April 2019
Line 8:		Line 8:

	==Clinical Features==		==Clinical Features==
			*Bulging fontanelle

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: Rossdonaldson1 moved page Bulging Fontanelle to Bulging fontanelle

2019-04-03T04:09:00Z

Rossdonaldson1 moved page Bulging Fontanelle to Bulging fontanelle

← Older revision	Revision as of 04:09, 3 April 2019
(No difference)

Mholtz at 22:56, 30 August 2017

2017-08-30T22:56:21Z

← Older revision		Revision as of 22:56, 30 August 2017
Line 51:		Line 51:

	==References==		==References==
	</~~references~~>		<references/>

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Symptoms]]		[[Category:Symptoms]]

Mholtz at 22:55, 30 August 2017

2017-08-30T22:55:45Z

@@ Line 1: / Line 1: @@
-==Pathophysiology==
+==Background==
-Fontanelles are fibrous membrane-covered gaps between cranial bones. A newborn has six fontanelles: anterior, posterior, two mastoid, and two sphenoid. The most prominent are the anterior and posterior fontanelles
+==Clinical Features==
 ==Differential Diagnosis==
@@ Line 34: / Line 35: @@
 *Viral syndromes
 *Hydrocephalus
 ==Management==
@@ Line 43: / Line 47: @@
 ''for a well appearing, asymptomatic, afebrile child with bulging fontanelle, an observation period may be appropriate.  In these stable children, if a subacute condition such as an asymptomatic space-occupying lesion is likely, he may benefit from admission and MRI''
-==Sources==
+==Disposition==
 [[Category:Pediatrics]]

Neil.m.young: Text replacement - " ==" to "=="

2016-08-03T15:20:09Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 15:20, 3 August 2016
Line 9:		Line 9:
	*The anterior fontanelle usually closes between 7-19 months of age.		*The anterior fontanelle usually closes between 7-19 months of age.

	==Differential Diagnosis ==		==Differential Diagnosis==
	*[[Meningitis (Peds)\|Meningitis]]		*[[Meningitis (Peds)\|Meningitis]]
	*[[Encephalitis]]		*[[Encephalitis]]