Objectives

The goal of this study was to determine the
relative frequencies of benign external hydrocephalus (BEH), hydrocephalus and
other conditions in a large series of imaging studies performed for
macrocephaly and identify additional risk factors for patients with
macrocephaly that would most likely benefit from neuroimaging evaluation.

Methods

Medical records at our center were searched for
the term macrocephaly retrospectively. The search extended from 1th January
2014 to 1th June 2019. Studies in patients older than 36 months of age were
excluded. Information about age, gender, symptoms and clinical signs (seizures,
neurologic abnormalities on exam such as hypotonia), neuroimaging findings, developmental
delay, family history of macrocephaly and head circumference (HC) were
collected for each patient.

Results

A total of 103 patients were included in the
analysis. The mean age at the time of imaging was 9 months (±5.5 months).
Twenty-one (20.3%) of the subjects were female and 82 (79.6%) were male.
Twenty-nine of the imaging studies were magnetic resonance imaging, 26 were
computed tomography and 65 were head ultrasounds. Patients with abnormal
neuroimaging results had significantly higher rates of developmental delay or
abnormal neurologic exam than patients with normal neuroimaging results or BEH
(p=0.003 and p<0.0001). There
was no significant difference between the neuroimaging results of patients with
and without positive family history of macrocephaly.

Conclusion

This study suggests that neuroimaging for
macrocephaly has almost negligible diagnostic yield unless having developmental
delay or abnormal neurological examination.

Keywords: Macrocephaly, benign external hydrocephalus, neuroimaging