Had another one of these! Probably the fourth or fifth of my brief career. A
febrile infant (8 month old) with a bulging fontanelle (noted by the parent
& confirmed by examining the baby sitting up with the baby not crying);
somewhat fussy but not "irritable". CSF was "stone cold" normal. The patient
looked well post tap.
I have chosen to call it the "Benign Bulging Anterior Fontanelle" syndrome.
Have folks seen this? What is the mechanism?
BTW, Jay (Fischer, MD) thanks for the references on C-Spine. I guess my
question is, what is the sensitivity of a lateral radiograph in a completely
lucid patient, with no distracting injuries, a non focal neurologic exam and
no midline c-spine tenderness, in a preverbal child. It is this age group,
where getting a good "odontoid" view is an ordeal. The frequently quoted
sensitivity of 70-80 % I believe, includes all comers, i.e even those who
may under the influence, have AMS etc ....etc.
Jay Pershad, MD
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