Sutures and Fontanelles: Widened Sutures as a Symptom of Defective Ossification



10.1055/b-0034-87891

Sutures and Fontanelles: Widened Sutures as a Symptom of Defective Ossification


In this instance, no signs of increased ICP are present. Usually, the suture has sharp edges without prominent interdigitations. Suture widening is often associated with numerous wormian bones and a persistent fontanelle.


Rare causes of widened sutures include the following:




  • Pseudotumor cerebri, brain edema of unknown cause, post-traumatic with headache and papilledema: normal US, CT, and magnetic resonance imaging (MRI) findings



  • Superior sagittal sinus (SSS) thrombosis: diagnosed by US (Doppler), CT, or MRI



  • Vitamin A toxicity or deficiency



  • Hyperparathyroidism



  • Long-term use of steroid medication



  • Long-term prostaglandin E1 therapy



  • Lead poisoning.












































Table 4.2 Widening of the sutures as a symptom of defective ossification

Diagnosis


Findings


Florid rickets


Indistinct suture margins, generally obscured osseous structures.


Hypothyroidism, untreated


Delayed closure of fontanelles, often numerous wormian bones.


Osteogenesis imperfecta


Numerous wormian bones are generally present; thinned calvarial bones.


Cleidocranial dysostosis


Fig. 4.2, p. 294


Persistent, large anterior fontanelle, numerous wormian bones.


Hypophosphatasia


Widely patent fontanelles, widened sutures.


Long-term prostaglandin E1 therapy


Widely patent fontanelles.


Pycnodysostosis


Persistent anterior fontanelle, wormian bones, and osteosclerosis.


Menke syndrome (kinky hair syndrome)


Numerous wormian bones, microcephaly.


Progeria


Extremely rare condition of premature aging.


Zellweger syndrome


Fig. 4.3a, b, p. 294


Fig. 4.4a, b, p. 295


Facial manifestations, wide sutures, hypotonia, developmental delay, hepatomegaly, peripheral retinal pigmentation.


Hallermann-Streiff syndrome (oculomandibulo-dyscephaly)


Delayed closure of fontanelles. Syndrome is characterized by birdlike face, micropthalmia, cataracts, micrognathia, beaked nose, abnormal dentition, hypotrichosis, cutaneous atrophy, and proportional small stature.

Fig. 4.2 Cleidocranial dysostosis in 4-year-old boy. Note the persistent open anterior fontanelle.
Fig. 4.3a, b Epilepsy in a 2-day-old infant. Note the large open anterior fontanelle and facial manifestations that are suspected to be part of Zellweger syndrome.
Fig. 4.4a, b Subependymal heterotopia as part of Zellweger syndrome on T1- and T2-weighted brain images of the same patient as Fig. 4.3 .

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Jul 12, 2020 | Posted by in PEDIATRIC IMAGING | Comments Off on Sutures and Fontanelles: Widened Sutures as a Symptom of Defective Ossification
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