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Pediatrics in Review is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuouslysince 1979. Pediatrics in Review is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1995 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0191-9601. Online ISSN: 1526-3347.
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youth been taking medications or excessive wrist extension on atCraniosynostosis might he or she have ingested a drug tempted finger flexion), dysmetria Craniosynostosis: A Review of 519 Surgical or poisons? Did the teenager drink (error in estimating the movement Patients. Shillito J Jr. Matson DD. alcohol or take other drugs? Could he distance of theexaminer’s finger as it Pediatrics. 1968:41:829-853 Craniosynostosis Update 1987. Cohen MM or she possibly have attempted suiis moved suddenly to various locaSuppi. I 988:4:99-I 48 cide? Does the child have or is there tions in one place). intention tremor, Jr. Am J Med (/e,iet Perspectives on Craniosynostosis. In: Cohen a family history of sickle cell disease, and smoothness of completing a MM Jr. ed.Cra,iio.sviiostosis: Diagiiosis. metabolic diseases, epilepsy, micomplex movement should be evaluetalIUItiO1i. (liii! Management. New York. graines, or Friedreich ataxia? Has ated. Obviously. some of these latter NY: Raven Press: 1986:21-57 Syndromes, (;enetics, and the Craniofacial there been a recent change in mental evaluations would be extremely diffiComplex. Marion RW. In: Goodrich JT,status? cult in a small child.
eds. Cra,iiofi,cial Anomalies: 10 Surgical Managemnemit. NY: Thieme Med Publishers.
New in press.
The neurobogic portion of the physical examination should be complete but reserved for last to lessen the likelihood that important general findings are missed. Important gencrabfindings include scars or crusty varicella lesions on the skin, the presence of fluid in the middle ear, cervical adenopathy. chest rales, cardiac arrhythmias, murmurs, splenomegaly, hepatomegaly, abdominal masses, and decreased muscle strength. As part of the neurobogic examination, papilledema or hemorrhages in the fundi should be noted. Also, whenever possible, asynergia (ebicted by
On the surface,premature closure of One of the more common causes of one or more sutures of the skull may ataxia can be evaluated by performappear to be a straightforward rnaling a dextrostix test. Other readily that leads to a specific, available, relatively inexpensive, and formation recognizable pattern of symptoms low-risk diagnostic tests are measurand signs, an anomaly that can be ing serum electrolytelevels, includcorrected simply by a surgical proceing determining bicarbonate level, But in fact, craniosynostosis, screening fIr toxins. and performing dure. occurs in approximately I in a lumbar puncture (if the diagnosis ofwhich 2500 children, is a dynamic process. meningitis is entertained and the the external reflection of a series of fundi are normal). complex conditions that may cause Moreelaborate and expensive an underlying abnormality not only tests, such as computed tomography in the skull but in other systems. or magnetic resonance imaging, are In most cases, surgical repair of performed best after consultation both the fused sutures and the resultwith a neurologist. ing craniofacial asymmetry will resolve the primary problems caused by craniosynostosis, namely. comTABLE....