Systematic Approach to Pediatric Macrocephaly

This podcast episode provides an overview of pediatric macrocephaly, its imaging modalities, and various conditions associated with it. It discusses the use of ultrasound, MRI, and CT for evaluation, highlighting the preference for ultrasound in young infants with open fontanelles. The podcast explains the involvement of different compartments in the classification of causes for macrocephaly, such as benign enlargement of the subarachnoid spaces. It discusses the identification and diagnosis of enlarged subarachnoid spaces, emphasizing the importance of distinguishing them from subdural fluid collections. Hydrocephalus is also explored as an important cause of pediatric macrocephaly, explaining the imbalance between CSF production and absorption and the role of aqueductal stenosis. Additionally, the episode touches on rare causes like hydranencephaly and the presence of cysts in the middle cranial fossa. The condition of Genesis of copus callosum with interhemisphere SIS is discussed, as well as the association of subdural fluid collections with accidental or non-accidental trauma in children. Overall, the episode provides comprehensive insights and diagnostic considerations regarding pediatric macrocephaly. Main points • Pediatric macrocephaly can be evaluated using ultrasound, MRI, and CT. • Benign enlargement of the subarachnoid spaces is a common cause of macrocephaly. • Distinguishing between enlarged subarachnoid spaces and subdural fluid collections is crucial. • Hydrocephalus is characterized by a mismatch between CSF production and absorption. • Aqueductal stenosis is a common cause of congenital hydrocephalus. • Rare causes of macrocephaly include hydranencephaly and ragnosis. • Genesis of copus callosum is associated with interhemisphere SIS and can be visualized on MRI. • Subdural fluid collections are commonly found in cases of accidental or non-accidental trauma in children. • Accurate diagnosis of subdural collections requires careful evaluation of clinical history and additional imaging findings. • Descriptive reporting is important to avoid erroneous dating and consider medical-legal implications.