Differential Diagnosis of Skull and Spine Disorders
- Caput succedaneum
= localized edema in presenting portion of scalp
Frequently associated with: microscopic hemorrhage and subcutaneous hyperemia
Cause: trauma of vaginal delivery
Location: commonly at vertex
- soft superficial pitting edema
- crosses suture lines
- Subgaleal hemorrhage
= hemorrhage between galea aponeurotica (= central fascia formed by occipitofrontal + temporoparietal muscles) and periosteum of outer table
- may become symptomatic ← significant blood loss in children
- firm fluctuant mass increasing in size after birth
- may dissect into subcutaneous tissue of neck
- usually resolves over 2–3 weeks
- Occasionally due to spontaneous decompression of intracranial (epidural) hematoma
- Cephalohematoma
= traumatic hematoma beneath outer layer of periosteum confined by cranial sutures
Cause: incorrect application of obstetric forceps / skull fracture during birth
Prevalence: 1–2% in spontaneous vaginal deliveries; 3–4% in forceps- / vacuum-assisted deliveries
Location: most commonly parietal
- firm tense mass; usually increase in size after birth
- resolution in few weeks to months
- crescent-shaped lesion adjacent to outer table of skull
- will not cross cranial suture line
- usually resolved by a few weeks to 3–4 months
- may calcify / ossify causing thickening of diploe ← prolonged resorption (= chronic cephalohematoma)
MR: - T1- and T2-hyperintense lesion ← subacute hemorrhage
Cx: infection
- Skull fracture
Frequency: 1% of all deliveries
- CT shows associated intracranial hemorrhage
- Subdural hemorrhage
- convexity hematoma
- interhemispheric hematoma
- posterior fossa hematoma
- Benign subdural effusion
= benign condition that resolves spontaneously
- clear / xanthochromic fluid with elevated protein level
- extracerebral fluid collection accompanied by ventricular dilatation (= communicating hydrocephalus caused by impaired CSF absorption of these subdural fluid collections)