Hairless Area at the Vertex

This slightly prominent hairless skin area reminds of a scar with a bluish design. Its midline position fits the picture of an abortive or occult encephalocele = atretic encephalocele. A visible and palpable pulsating bony defect, the level of which becomes elevated during crying is a further characteristic sign. Yet, in the demonstrated case a hemangioma was found histologically. The preoperative differential diagnosis is important because a plastic closure of the dura and bone defect is necessary in case of a typical encephalocele. On the other hand, in larger occipital or parietal encephaloceles the diagnosis is easy.