Differential Diagnosis for a 3-week-old with Bulging Anterior Fontanelle and No Post-Birth Care

• Single Most Likely Diagnosis
  • Congenital hydrocephalus or acquired hydrocephalus due to infection or intracranial hemorrhage: This condition is likely due to the lack of post-birth care, which could have led to undiagnosed infections or other complications. The bulging anterior fontanelle is a classic sign of increased intracranial pressure, which is consistent with hydrocephalus.
• Other Likely Diagnoses
  • Meningitis: Infection is a significant concern in a newborn without post-birth care, and meningitis can cause increased intracranial pressure, leading to a bulging fontanelle.
  • Intracranial hemorrhage: Lack of proper care could increase the risk of trauma or other conditions leading to bleeding within the skull.
  • Congenital infections (e.g., toxoplasmosis, cytomegalovirus): These infections can cause a range of neurological symptoms, including increased intracranial pressure.
• Do Not Miss Diagnoses
  • Brain tumor: Although rare in newborns, a brain tumor could cause increased intracranial pressure and must be considered to ensure prompt treatment.
  • Traumatic brain injury: Accidental or non-accidental trauma could lead to increased intracranial pressure and must be ruled out.
  • Metabolic disorders (e.g., maple syrup urine disease): Certain metabolic disorders can lead to increased intracranial pressure and have severe consequences if not promptly diagnosed and treated.
• Rare Diagnoses
  • Vein of Galen malformation or other vascular malformations: These are rare congenital conditions that can cause increased intracranial pressure due to abnormal blood flow.
  • Craniosynostosis: Premature closure of the skull sutures can lead to increased intracranial pressure, although it might not typically present with a bulging fontanelle this early.
  • Neurocutaneous syndromes (e.g., tuberous sclerosis): These syndromes can have neurological manifestations, including increased intracranial pressure, but are less common and might have other distinguishing features.