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Kleeblattschadel syndrome or cloverleaf skull syndrome is a n unusual and rare form of congenital hydrocephaly caused by premature fusion of the coronal and lambdoidal sutures. The resultant increased intracranial pressure causes formation of a grotesque trilobed skull. Other associated anomalies include low-set ears and petrous ridges, varying degrees of exophthalmos, facial deformities, long-bone abnormalities, and gastrointestinal tract abnormalities. This report describes the intrauterine sonographic appearance of such an infant. CASE REPORTA healthy 30-year-old Caucasian woman (gravida 3, para 1, abortus 1) was referred for sonographic gestational dating prior to expected repeat cesarean section. The initial examination a t 18 weeks by menstrual dates showed biparietal diameters corresponding to a 15.7-week fetus. At 32 weeks by menstrual dates the biparietal diameters corresponded to a 25.3-week fetus. The head was normally shaped, and no other fetal abnormalities were appreciated in either examination, even in retrospect (Fig. 1).Three weeks later the head measurements indicated 26.9 weeks, rather than the expected 35 weeks by biparietal diameters. The head-thorax ratio measured 0.78, and the lateral ventricles were thought to be dilated (Fig. 2).The last scan a t 37 weeks of gestation by menstrual dates demonstrated the retarded cranial size (30.4 weeks), the lateral ventricular enlargement, the abnormal head-thorax ratio, and

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