Our approach to the evaluation of the child with macrocephaly

This algorithm is intended for use in conjunction with the UpToDate topic on macrocephaly in children. The baseline evaluation includes history and physical examination with particular attention to:

History: CNS trauma or infection; associated neurologic symptoms (eg, headache, vomiting, ataxia, altered mental status)
Physical examination: Delayed development, bulging fontanelle (in infant), papilledema, meningismus, or other abnormal neurologic findings; neurologic or cutaneous findings suggestive of multisystem disease or syndrome
Family history: Macrocephaly, multisystem disease or syndrome
Measurement of parents' OFC

OFC: occipitofrontal circumference; ICP: intracranial pressure; CNS: central nervous system; SD: standard deviation; MRI: magnetic resonance imaging.
* Progressive enlargement is defined by crossing ≥1 major percentile line (eg, 10^th, 25^th, 50^th, 75^th, 90^th) between health supervision visits.
¶ Refer to UpToDate content on increased intracranial pressure, meningitis, and encephalitis in children for details.
Δ Refer to UpToDate content on macrocephaly in children for details.
◊ Refer to UpToDate content on developmental surveillance and screening. Children with macrocephaly and developmental delay or neurologic findings may warrant neurology referral or consultation in addition to neuroimaging.
§ The laboratory evaluation varies with the clinical manifestations. Refer to UpToDate content on inborn errors of metabolism for details of evaluation.

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Our approach to the evaluation of the child with macrocephaly