Head growth and cranial assessment at neurological examination in infancy

Abstract

The most dramatic increase in brain volume occurs in the last three months of fetal life and the first two years after birth. Concomitantly, the skull follows the volumetric increase in the cerebral hemispheres mostly by passive adaptation. The relationship between head and brain growth explains why the classical neurological assessment in infancy universally includes measurement of head circumference (HC). However, this crude information derived from HC measurement remains insufficient to qualify brain growth. One way to better document the relation between brain and skull could be to rely on the correlation between HC and body growth parameters, given a general agreement on the definition of proportionate and disproportionate head–body growth. Significant information with respect to the integrity of the underlying cerebral hemispheres can also be provided by systematic palpation of the main cranial sutures. In particular, the distension or overlapping of the squamous sutures which are strategically located at the junction of the cranial vault and the cranial base could be a valid marker of brain growth disorder.