Progressive postnatal pansynostosis

Case contributed by Dalia Ibrahim


Young girl with Crouzon syndrome presented with headache and vomiting. Physical exam revealed a normal head shape. On fundoscopy, bilateral grade I papilledema. Serial measurement of head circumference showed a decline in percentile head size starting from 38 months old.

Patient Data

Age: 5 years
Gender: Female

An unenhanced brain CT was performed. Topogram showed copper beaten skull. Axial CT soft tissue cuts revealed signs of increased intracranial pressure with effacement of the ventricles, basal cisterns and other CSF spaces.

Bone window series showed characteristic endocortical scalloping, widened left mastoid emissary foramina and prominent subgaleal veins, consistent with venous hypertension. 3D volume rendered bone window showed fusion of all major cranial sutures (pansynostosis).

Case Discussion

Progressive postnatal pansynostosis is a rare form of craniosynostosis characterized by late fusion of all cranial sutures. 

This type of craniosynostosis occurs insidiously after birth and presents later in life, unlike other types of craniosynostosis which occur during the prenatal period. 

The late fusion of cranial sutures means that the diagnosis is delayed and typically presents with signs of increased intracranial pressure with a rather normal, albeit smaller than average, head size.

The sagittal suture typically closes at around 22 years of age; the coronal suture closes at around 24 years; and the lambdoid and squamosal sutures close at around 26 and 60 years, respectively.1

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