Sutures - separated

Alternative names:

separation of the sutures

Definition:

Separation of the bony sutures of the skull in an infant.

Considerations:

The skull of a young infant and young child is made up of bony plates that allow for growth of the skull. The borders along which these plates intersect are called sutures or suture lines. In an infant only a few minutes old, the pressure from delivery compresses the head, making the bony plates overlap at the sutures and creating a small ridge. This is a normal finding of newborns. In the next few days the head expands, the overlapping disappears, and the edges of the bony plates meet edge to edge. This is the normal position.

Diseases or conditions that cause abnormal pressure increases within the head cause the head size to grow rapidly spreading the sutures apart. These separated sutures are indicative of increased intracranial pressure (pressure within the skull). Separated sutures usually are associated with a bulging fontanel and, if intracranial pressure is significantly increased, prominent veins over the scalp. The fontanels are usually closed by 18 months (sometimes as early as 9-10 months) and the sutures fused together by 2 years, at which time they cease to be a reliable indicator of increased intracranial pressure

Common causes:

• meningitis
• agenesis of the corpus callosum
• Dandy-Walker malformation
• Arnold-Chiari malformation
• battered child syndrome
• hydrocephalus
• congenital CMV (in-uterine infection of the fetus with cytomegalovirus)
• congenital listeriosis (in-uterine infection of the fetus with Listeria monocytogenes)
• brain tumor
• intraventricular hemorrhage (bleeding inside the brain)
• subdural hematoma or subdural effusion
• hypervitaminosis A (excessive intake of toxic levels of vitamin A)
• lead poisoning
• Down syndrome
• hypothyroidism
• rickets (bone disease caused by deficiency of vitamin D)

Note: There may be other causes of separated sutures. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as location, quality, time course, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for separated sutures, occurring alone or in combination with other problems.