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Arch Pediatr Adolesc Med. 1998;152:608.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with great interest the article by Rothman and Lee¹ in the January issue of the ARCHIVES. A bulging fontanel is a medical emergency because of its association with serious underlying central nervous system disease.^2-4 Drs Rothman and Lee have demonstrated radiographically the pathophysiology of bulging fontanel and meningitis.

Once a child with bulging fontanel has had meningitis ruled out, other pathologic (tumor, lead poisoning, sinus thrombosis, encephalitis, hydrocephalus, intracranial abscess, or hemorrhage) and nonpathologic (intracranial and metabolic disease, nutrition, toxic drug effects, impaired cerebrospinal fluid absorption, viral infections, and catch-up brain growth) causes must be considered.^2-6 It will be important to determine if these other causes produce a bulging anterior fontanel through the same mechanism of expanding subarachnoid space. For these conditions, bulging anterior fontanel may be the result of other underlying pathophysiologic mechanisms such as brain parenchyma expansion, increased intravascular volume, subdural space changes, or ventricular enlargement, . . . [Full Text of this Article]

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