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hydrocephaly / CT scan for infants

  My son is 9-months old and perfectly happy and healthy.  
  From the time he was about 2-months old his doctor has been concerned about
  the size of his head.  The circumference of his head has consistently been
  in the 95th (or higher) percentile, while his height and weight have
  levelled out at around 25th percentile.  MOre importantly, from my
  understanding, his head is growing at a faster rate than his overall
  skeletal growth.  To look at him, he has a perfectly round and really
  beautiful head!  But, the charts concern the doctor and she has us all
  worried about hydrocephaly.  An ultrasound at 8-months old was perfectly
  normal -- but this did not satisfy her.  Let me add that there is a definite
  genetic link for big heads!  He looks exactly like his grandfather as an
  infant.  There are no other symptoms that
  she has been able to identify.  Now she is ordering a CT scan.  I would
  like to put this to rest, on the one hand, but I'm really wary of
  unneccessary testing.  
  Do I just have an overcautious doctor??  Do pediatricians send every 95th
  percentile head off for testing??  She says that mild hydrocephaly and
  surgical insertion of shunts are "COMMON" and that her office does about
  THREE a year.  Does this sound right?  EVerything I have read says it's
  RARE and nothing mentions the onset in later months (i.e. everything seems
  to refer to prenatal or diagnosis at birth).  
  I guess I"m asking...what questions should I be raising?  Should I just
  agree to the CT scan?  Where can I find more information or alternative
  opinions?  What are the risks to my son if we "do nothing" right now?  Isn't
  it possible he may not "grow into" his head until he's a toddler?
  Thanks in advance for any info or similar experiences to share.
Dear Tiffany:
In normal, healthy infants, the rate of increase of the head circumference, the length,
and the weight is usually quite similar even though the head, the length, and weight may not
follow the same growth lines(curves). Head growth usually reflects growth of the underlying brain.
Some normal infants do have disproportionately large heads compared to their lengths and weights.
Indeed, some families simply have healthy members with much larger heads - a benign familial pattern.
This could indeed be the case in your family. However, sometimes a disproportionately large head can
reflect a pathological process (hydrocephalus) involving obstruction of the flow of cerebrospinal fluid
through chambers inside the brain called ventricles. On other occasions, it may reflect the accumulation
of fluid between the brain and its overlying membranes (subdural hematoma or a subdural
effusion). Rarely, it may reflect the growth of a tumor inside the head. Usually in these latter cases
the infant does not thrive. If the soft spot (anterior fontanelle) is still open, a carefully performed
and properly interpreted head ultrasound will identify these pathological conditions in an infant with an
unusually large head. Clearly, a CT scan or a magnetic resonance imaging study will provide much more
detailas well as necessary guidance for surgical management.
It might be helpful for you to sit down with your child's physician as well as perhaps the radiologist who
would perform the CT scan or MRI to better understand the potential yield and the risks of such an additional
study of your son. It might be useful to ask why just repeating the ultrasound
(if any additional study is necessary) wouldn't suffice. Another option would be to ask your child's physician
if she would be willing to prepare a summary of your son's evaluation to date, share it with you, and send it(and
the ultrasound) to a pediatric neurosurgeon to obtain a second opinion. That written opinion could then be shared
with you. Finally, a direct referral to a pediatric neurosurgeon would permit you to review the matter directly
before other studies are carried out.
Decision-making in medicine is often very difficult. I do not want to second guess your child's physician.
After all, she has direct access to the facts of the matter. There may be some variables in play of which I am unaware.
My response simply is intended to assist you in framing the questions to provide you with the answers you as parent need
in order to feel you are doing the right thing by your son.
This information is provided for educational purposes only. I hope I have been of some assistance.
KEYWORDS: macrocephaly

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Avatar universal
I have a 13 month old little boy who has also has a larger than average head. We saw a neurologist and he's ordered a ct scan. I'm nervous about it and came across your post. What happened with your situation

Thanks! Shannon
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