Hydrocephalus vs. Constitutional Macrocrania

Left picture: The two case reports show examples of hydrocephalus, and the way to recognize them by means of head circumference measurement. Right picture: This is an example of the course of the head circumference in a patient with constitutional macrocrania (also called benign macrocephaly). Today, the course of the head circumference is more important than a single value because the clinically recognizable cases of hydrocephalus with split sutures, prominent and tight fontanel and phlebectasia are rarely encountered. Also in case of suspected constitutional macrocrania (large heads in the family, harmonious relation between neurocranium and facial skull), the course of head circumferece is important, the head circumference usually lying at or barely above the 97th percentile, as in the reported case. Nevertheless, single deserters (also shown in the case report) can cause uncertainty. They may be caused either by a somewhat divergent technique of measurement, or by an individually inhomogeneous growth of head circumference.

In both cases the values of head circumference lie at, or barely or distinctly above, the 97th percentile. Left picture: In both case reports (marked with 1 and 2) the values of head circumference lie distinctly above the 97th percentile or leave successively the normal range. Right picture: The values of the head circumference follow the 97th percentile with one exception.