Neurology Main神经内科 161-170-课件.ppt

Neurology Main 161-170 Q 161A 10-hour-old newborn is noted to have a swelling in the scalp which was not present at birth. The swelling is limited to the surface of one cranial bone. There are no visible pulsations, indentations of the skull, or discoloration of the overlying scalp. What is the most likely diagnosis?A. Cephalohematoma B. Caput succedaneum C. Cranial meningoceleD. Intracranial hemorrhage E. Depressed skull fracture A 161Correct answer:AThis is a classic presentation of a cephalohematoma. Cephalohematoma is a subperiosteal hemorrhage; hencer it is always limited to the surface of one cranial bone. There is no discoloration of the overlying scalp, and swelling is usually not visible until several hours after birth because subperiosteal bleeding is a slow process. Most cases do not require any treatment and resorb spontaneously within 2 weeks to 3 months, depending on the size. Rarely, phototherapy may be necessary to improve the hyperbilirubinemia.(Choice B) Caput succedaneum is a diffuse, sometimes ecchymotic： swelling of the scalp. It usually involves the portion of the head presenting during vertex delivery. It may extend across the midline and across suture lines.(Choice C) Crania! meningocele is characterized by the presence of pulsations, increased pressure upon crying, and roentgenographic evidence of bony defects.(Choice D) Intracranial hemorrhage in neonates classically presents as periods of apnea, pallor or cyanosis, poor suckling, abnormal eye signs, high-pitched cry, muscular twitching, convulsions, decreased muscle tone or paralysis, decreased hematocrit, metabolic acidosis, and shock. Fontanels may be tense and bulging. Swelling of the scalp does not occur,(Choice E) Depressed fractures are indentations of the calvarium similar io a dent in a ping-pong ball. These are usually complications of forceps delivery or fetal head compression. Although underlying skull fractures are occasionally associated with cephalohematoma, these are usually