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

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 old

M , 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