Parietal Pseudofracture and Spontaneous Intracranial Hemorrhage Suggesting Nonaccidental Trauma: Report of 2 Cases

Fenton, Laura Z.; Sirotnak, Andrew; Handler, Michael H.

doi:10.1159/000055978

Cited by 23 publications

(10 citation statements)

References 5 publications

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“…He confirms the condition is rare, and notes that in his review of 25,000 radiographs he found only three cases of complete parietal divisions. In addition, Fenton et al (2000) report two cases of divided parietal bones found at autopsy. In these cases, radiographs of two infants were obtained in the context of workup for bleeding disorders, and the divided parietal bones were initially interpreted as linear parietal fractures.…”

Section: Discussionmentioning

confidence: 96%

Os parietale divisum

et al. 2005

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Divisions of the parietal bone are extraordinarily rare, and have been described previously only in skull specimens in the anatomical literature. We report a case of os parietale divisum (divided parietal bone) in an infant with plagiocephaly. A 36-weeks gestation male with multiple congenital anomalies presented to the deformational plagiocephaly clinic at 11 weeks of age. CT imaging demonstrated a suture dividing the left parietal bone into two segments. He had a plagiocephalic appearance, with the greater occipital and parietal protuberances ipsilateral to the abnormal left parietal suture, and a correspondingly flatter right occiput. Head circumference was in the normal range, and the anterior fontanelle was patent and of normal size. He had mild right-sided right frontal and malar protuberance. Mandibular asymmetry was noted with a chin-point to the right of midline. He had a left-sided head tilt. He was treated with cranial molding helmet therapy for his head shape and physical therapy for his head tilt. After 16 months of helmet therapy, he had little improvement of his head shape. This case is an in vivo presentation of a rare variant, os parietale divisum.

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Section: Discussionmentioning

confidence: 96%

Os parietale divisum

et al. 2005

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“…5 Anomalous sutures or "pseudofractures" are typically identified on radiographic examinations, and to our knowledge, only one other case report describes examining a pseudofracture histologically. 6 Fenton et al reported 2 cases of children with intracranial hemorrhage and parietal skull fractures. Both children were found to hypercoagulable states which caused their hemorrhages, no other evidence of nonaccidental trauma and histologic examination of the fracture identified an anomalous suture in 1 and a connective tissue fissure in the other.…”

Section: Discussionmentioning

confidence: 99%

Anomalous Parietal Suture Mimicking Skull Fracture

Tharp¹,

Jason²

2009

American Journal of Forensic Medicine &Amp; Pathology

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Anomalous sutures of the parietal bone are exceedingly rare events. We present the case of a child admitted to the hospital after a near-drowning incident who subsequently expired. He was diagnosed with a parietal skull fracture by computed tomography scan before death. This was found to be an anomalous suture by postmortem histologic examination. Division of the parietal bone is an unusual event with anomalous sutures, which can be mistaken for fractures on radiographic or postmortem examination. Although fractures are much more common, it is prudent to evaluate all fractures and/or fracture-like abnormalities by histologic examination when possible to avoid misdiagnosing blunt trauma to the head.

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“…One child was delivered at home by a midwife and did not receive vitamin K (20), one family refused vitamin K (21), and the third received two doses of vitamin K but had prolonged gastroenteritis that resulted in a malabsorption state (22). In all three reports the diagnosis of VKDB was made retrospectively after death.…”

Section: Discussionmentioning

confidence: 99%