Congenital Hydrocephalus vs. Sagittal Synostosis

Left picture: The 2-day-old neonate has a congenital hydrocephalus. Right picture: In this 4-month-old boy a sagittal synostosis is present. Scaphocephaly (= too long and small head) as in the presented case may arise the suspicion of hydrocephalus because the values of head circumference lie often on the 97th percentile, or even higher. In scaphocephaly the head circumference lies often in the high percentiles for geometrical reasons because the so-called normal values of the head circumference have been derived from individuals with a normally proportioned skull.

Left picture: In this pathology a large head attracts attention on viewing from the top. Right picture: In this pathology the head is remarkably long. The value of the head circumference lies often on the 90th, 97th percentile or higher in such cases. Left picture: The skin is shiny and tight, and on looking closely, a vein is visible running forward from behind, and lanugo hair is recognizable laterally on the head. Right picture: The hair is robust, the skin is inconspicuous, and the quotient breadth to length is smaller than 0.70.