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Images in neonatal medicine
Diagnosis of hydrocephalus by cranial transillumination
  1. Berenice Xueli Lian1,
  2. Nicholas Beng Hui Ng1,
  3. Furene Wang1,
  4. Vincent D W Nga2,
  5. Ai Peng Tan3,
  6. Jeremy Lin1
  1. 1 Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
  2. 2 Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
  3. 3 Department of Diagnostic Imaging, National University Hospital, Singapore
  1. Correspondence to Dr Nicholas Beng Hui Ng, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore; nicholas_bh_ng{at}nuhs.edu.sg

https://doi.org/10.1136/archdischild-2021-322430

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    A full-term neonate was examined to have significant macrocephaly (>>97th percentile), widened cranial sutures and a large bulging anterior fontanelle (AF). A light-emitting diode source applied on the AF revealed asymmetrical cranial transillumination, predominantly on the right (figure 1A). He was alert with spontaneous movements of all limbs but had generalised upper motor neuron (UMN) signs of hypertonia and hyper-reflexia. These signs indicated raised intracranial pressure from a possible right hemispheric cystic lesion.

    Figure 1

    (A) Cranial transillumination of the skull through the anterior fontanelle showing asymmetrical transillumination, affecting …

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    Footnotes

    • Contributors BXL collected and interpreted the data and wrote the initial draft of the manuscript. NBHN interpreted the data, did the literature review, wrote the initial draft of the manuscript and revised the manuscript critically for important intellectual content. WF and VDWN interpreted the data and revised the manuscript critically for important intellectual content. APT provided the radiology images, interpreted the data and revised the manuscript critically for important intellectual content. JL designed the case presentation, collected and interpreted the data, performed the literature review and revised the manuscript critically for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.