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Newborn with a depression to her skull
Accepted Manuscript Newborn with a depression to her skull
Simona Rudnin, Jeremy Neuman, Josh Greenstein, Barry Hahn PII: DOI: Reference:
S0735-6757(18)30532-1 doi:10.1016/j.ajem.2018.06.053 YAJEM 57633
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
20 June 2018 21 June 2018
Please cite this article as: Simona Rudnin, Jeremy Neuman, Josh Greenstein, Barry Hahn , Newborn with a depression to her skull. Yajem (2018), doi:10.1016/j.ajem.2018.06.053
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Newborn with a depression to her skull
Simona Rudnin MD1, Jeremy Neuman MD2, Josh Greenstein MD1, Barry Hahn MD1 1
From the Department of Emergency Medicine, Staten Island University Hospital, Northwell
Health, Staten Island, NY.
T
From the Department of Radiology, Staten Island University Hospital, Northwell Health, Staten
IP
2
CR
Island, NY.
Address for correspondence and reprints: Josh Greenstein, MD, Department of Emergency
US
Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305.
AN
Fax: 718-226-6964; e-mail: [email protected] .
AC
CE
PT
ED
M
Word Count (discussion): 236
ACCEPTED MANUSCRIPT A 9 week-old female, born via normal spontaneous vaginal delivery at 40 weeks, presented to the emergency department for a depression to her left skull, first noticed three weeks prior. Both parents denied perinatal or postnatal trauma. The child had been gaining weight appropriately and no behavioral dysfunction was noticed. On examination, a depression to the left parietal skull was present. A computed tomography (CT) of the head was obtained (Figures 1 and 2).
Discussion:
CR
IP
T
Ping Pong Fracture (PPF). PPFs are depressed skull fractures, caused by inner buckling of the calvarium. The newborn skull is soft and highly malleable allowing for this deformity. Therefore, PPF can be considered a “greenstick fracture” of the skull. The defect is referred to as a PPF because the shape of the indention mimics the appearance of a depressed ping pong ball.
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In the neonatal period, congenital skull depressions have an incidence of 1 in 10,000 births and are typically due to perinatal trauma. Alternatively, they can be a result of blunt trauma within the first few months of life. Occasionally, they are found spontaneously, in uneventful pregnancies and no history of trauma. PPFs are seldom associated with intracranial injury or neurologic sequelae. CT scan of the head is usually the initial imaging modality of choice for evaluation. While treatment is controversial, most can be treated with non-invasive devices or may resolve on their own. Severe cases may require surgical intervention.
References
PT
1 Mastrapa TL, Fernandez LA, Alvarez MD, Storrs BB, Flores-Urueta A. Depressed skull fracture in Ping Pong: elevation with Medeva extractor. Childs Nerv Syst 2007;23:787-90.
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2 Skull fracture [Internet]. MedlinePlus Medical Encyclopedia. [cited 2018Mar19]. Available from: https://medlineplus.gov/ency/article/000060.htm
AC
3 Zalatimo O, Ranasinghe M, Dias M, Iantosca M. Treatment of depressed skull fractures in neonates using percutaneous microscrew elevation. [Internet]. Journal of neurosurgery. Pediatrics. U.S. National Library of Medicine; 2012 [cited 2018Mar19]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22656262 4 Arifin MZ, Gill AS, Anwar AD, Djuwantono T, Faried A. Spontaneous depressed skull fracture during vaginal delivery: A report of two cases and literature review. The Indian Journal of Neurotrauma. 2013;10(1):33–7.
5 Ben-Ari Y, Merlob P, Hirsch M et al. Congenital depression of the neonatal skull. Eur J Obstet Gynecol Reprod Biol 1986;22:249
ACCEPTED MANUSCRIPT 6 Cizmeci MN, Kanburoglu MK, Cemil B, Gokce EC, Tatli MM. Ping pong fracture in the newborn: illustration of a case. Acta Neurologica Belgica. 2013Jan8;114(1):69–70.
Legend Figure 1 – Axial CT image of the skull (bone windows) demonstrates an area of skull depression in the left parietal bone (arrow). No discreet fracture line is seen.
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Figure 2 – 3D reconstructed CT image from the frontal projection shows the left parietal bone depression (arrow) in better detail.
Figure 1
Figure 2
Simona Rudnin, Jeremy Neuman, Josh Greenstein, Barry Hahn PII: DOI: Reference:
S0735-6757(18)30532-1 doi:10.1016/j.ajem.2018.06.053 YAJEM 57633
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
20 June 2018 21 June 2018
Please cite this article as: Simona Rudnin, Jeremy Neuman, Josh Greenstein, Barry Hahn , Newborn with a depression to her skull. Yajem (2018), doi:10.1016/j.ajem.2018.06.053
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Newborn with a depression to her skull
Simona Rudnin MD1, Jeremy Neuman MD2, Josh Greenstein MD1, Barry Hahn MD1 1
From the Department of Emergency Medicine, Staten Island University Hospital, Northwell
Health, Staten Island, NY.
T
From the Department of Radiology, Staten Island University Hospital, Northwell Health, Staten
IP
2
CR
Island, NY.
Address for correspondence and reprints: Josh Greenstein, MD, Department of Emergency
US
Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305.
AN
Fax: 718-226-6964; e-mail: [email protected] .
AC
CE
PT
ED
M
Word Count (discussion): 236
ACCEPTED MANUSCRIPT A 9 week-old female, born via normal spontaneous vaginal delivery at 40 weeks, presented to the emergency department for a depression to her left skull, first noticed three weeks prior. Both parents denied perinatal or postnatal trauma. The child had been gaining weight appropriately and no behavioral dysfunction was noticed. On examination, a depression to the left parietal skull was present. A computed tomography (CT) of the head was obtained (Figures 1 and 2).
Discussion:
CR
IP
T
Ping Pong Fracture (PPF). PPFs are depressed skull fractures, caused by inner buckling of the calvarium. The newborn skull is soft and highly malleable allowing for this deformity. Therefore, PPF can be considered a “greenstick fracture” of the skull. The defect is referred to as a PPF because the shape of the indention mimics the appearance of a depressed ping pong ball.
ED
M
AN
US
In the neonatal period, congenital skull depressions have an incidence of 1 in 10,000 births and are typically due to perinatal trauma. Alternatively, they can be a result of blunt trauma within the first few months of life. Occasionally, they are found spontaneously, in uneventful pregnancies and no history of trauma. PPFs are seldom associated with intracranial injury or neurologic sequelae. CT scan of the head is usually the initial imaging modality of choice for evaluation. While treatment is controversial, most can be treated with non-invasive devices or may resolve on their own. Severe cases may require surgical intervention.
References
PT
1 Mastrapa TL, Fernandez LA, Alvarez MD, Storrs BB, Flores-Urueta A. Depressed skull fracture in Ping Pong: elevation with Medeva extractor. Childs Nerv Syst 2007;23:787-90.
CE
2 Skull fracture [Internet]. MedlinePlus Medical Encyclopedia. [cited 2018Mar19]. Available from: https://medlineplus.gov/ency/article/000060.htm
AC
3 Zalatimo O, Ranasinghe M, Dias M, Iantosca M. Treatment of depressed skull fractures in neonates using percutaneous microscrew elevation. [Internet]. Journal of neurosurgery. Pediatrics. U.S. National Library of Medicine; 2012 [cited 2018Mar19]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22656262 4 Arifin MZ, Gill AS, Anwar AD, Djuwantono T, Faried A. Spontaneous depressed skull fracture during vaginal delivery: A report of two cases and literature review. The Indian Journal of Neurotrauma. 2013;10(1):33–7.
5 Ben-Ari Y, Merlob P, Hirsch M et al. Congenital depression of the neonatal skull. Eur J Obstet Gynecol Reprod Biol 1986;22:249
ACCEPTED MANUSCRIPT 6 Cizmeci MN, Kanburoglu MK, Cemil B, Gokce EC, Tatli MM. Ping pong fracture in the newborn: illustration of a case. Acta Neurologica Belgica. 2013Jan8;114(1):69–70.
Legend Figure 1 – Axial CT image of the skull (bone windows) demonstrates an area of skull depression in the left parietal bone (arrow). No discreet fracture line is seen.
AC
CE
PT
ED
M
AN
US
CR
IP
T
Figure 2 – 3D reconstructed CT image from the frontal projection shows the left parietal bone depression (arrow) in better detail.
Figure 1
Figure 2