SCURVY (cont.)

• Epiphyseal separation or fragmentation in the region of metaphysis

• Dense , linear calcification at metaphyseal end “ White line of Frankel”

• Bony spur “ Pelkan spur “

• Transverse radiolucent band “ Scurvy line “

• Subperiosteal hematoma

Osteoporosis

Thinning of cortex

Thin , dense ring-like epiphysis = Wimberger’s ring

Dense linear calcification at distal metaphysis = White line of Frankel

Bony spur = Pelkan spur

Transverse radiolucent zone = Truemmerfeld zone

Subperiosteal hematoma

Osteoporosis

Thinning of cortex

Thin , dense ring-like epiphysis = Wimberger’s ring

Dense linear calcification at distal metaphysis = White line of Frankel

Bony spur = Pelkan spur

Transverse radiolucent zone = Truemmerfeld zone

Subperiosteal hematoma

Neurological Disease in

Children

NORMAL SKULL FILM

CRANIOFACIAL RATIO :

Newborn : 4 - 4.5 : 1

2 years : 3 - 3.5 : 1

6 years : 2.5 : 1

Adult : 1.5 - 2 : 1

SUTURE : Newborn ~ 1cm

3 years ~ 2 mm

Moulding = Parietooccipital overlapping : upto 2 weeks

Sutures close ~ 14 years old

NORMAL SKULL FILM cont.

FONTANELLE :

• Anterior F. close ~ 1.5 years ( 15 - 18 months )

• Posterior F close ~ 0.5 year ( 2 - 6 months )

CONVOLUTIONAL MARKINGS :

• Visible at 2 years

• Maximal apparence at 4 years

• Disappear by 8 years

6 days old

F , 10 months oldF , 10 months old

M , 5 years 7 monthsM , 5 years 7 months

NORMAL SKULL FILM

WORMIAN BONES :

• Island of bones within A & P fontanelle,

Lambdoid and posterior sagittal sutures

• Abnormal in : Cliedocranial disostosis ,

cretinism , etc.

WIDE SUTURES : DDx

• Increased intracranial pressure :

Obstruction of ventricular system = hydrocephalus

Space occupying lesion +/- hydrocephalus : mass, cyst

Brain edema

• Infiltration in sutures

Neuroblastoma

Leukemia

Lymphoma

SIGN OF INCREASED INTRACRANIAL PRESSURE

• Increased head size and craniofacial ratio

• Separation of sutures before 10 years ( esp. in 1 - 5 yrs old )

• Increased convolutional markings

• Pressure change of sella tursica

Anterior wall of dursum sella and posterior clinoid

process

Floor of sellar tursica and posterior wall of dorsum

sella

Enlarged sella tursica and change in shape