Note the general size and shape. Normocephalic is the term that denotes a round symmetric skull that is appropriately related to body size. Be aware that "normal" includes a wide range of sizes.

To assess shape, place your fingers in the person's hair and palpate the scalp. the skull normal feels symmetric and smooth. cranial bones have normal protrusion on forehead, the side of each parietal bone, the occipital been, and the mastoid process behind each ear.

head position is centered in the midline, the accessory neck muscle should be symmetric, the head erect and still

not any limitation of movement during active motion. ask the person to touch the chin to the chest and turn head left to right, try to touch each ear to the shoulder, and extend the head backwards.

test muscle strength and the status of CRANIAL NERVE XI by trying to resist the person's movement with your hands as the person shrugs the shoulder and turns the head to each side. 

as person moves their head note enlargement of salivary or lymph glands, swollen parotid gland, or thyroid. also note any obvious pulsations, the carotid artery runs medial to the sternomastoid muscle and it creates a brisk localized pulsation just below the angle of the jaw

• using a gentile circular motion of your finger pads, palpate the lymph nodes. beginning with the pre auricle lymph nodes, palpate the 10 groups of lymph nodes in a routine order. Many nodes are closely packed so you must be systematic and thorough in your exam
• use gentle pressure because strong pressure could push the nodes into the neck muscles. it is usually most efficient to palpate with both hands when comparing the two side symmetrically.

• for deep cervical chain, tip the person's head toward the side being examined to relax the ipsilateral muscle. then you can press your fingers under the muscle, search for the supraclavicular node by having the person hunch the shoulders and elbows forward; this relaxes the skin.

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Lymphadenopathy

• the thyroid gland is difficult to palpate
• position a standing lamp to shine tangentially across the neck to highlight any possible swelling. tilt the head back to stretch the skin against the thyroid. supply the person with a glass of water and first inspect the neck as the person takes a sip and swallows. thyroid tissue moves up with a swallow, then falls into resting position

If the thyroid gland is enlarged, auscultate it for the presence of a bruit. this is a soft, pulsatile whooshing, blowing sound heard best with the bell of the stethoscope.

Bruit occurs with accelerated or turbulent blood flow, indicating hyperplasia of the thyroid.

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Caput Succedaneum

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Cephalhematoma

is a subperiosteal hemorrhage, which is also a result of birth trauma. It is soft, fluctuant, and well defined over one cranial bone because the periosteum holds the bleeding in place. no discolor is present, but it looks bizarre 

an infant with cephalhematoma is at greater risk for jaundice as the red blood cells within the hematoma are broken down and resorbed. sutures palpable when the child is older than 6 months.

Positional Plagiocephaly

(positional molding)

may occur if the infant continually sleeps in the recommended position on the back to decrease the incidence of sudden infant death (SIDS).

this is a flattening of the dependent cranial bone, the occiput, in an infant who did not have occipital flatness at birth

a true tense or bulging fontanel occurs with acute increased intracranial pressure, depressed and sunken fontanels occur with dehydration and malnutrition. 

marked pulsations occur with increased intracranial pressure 

delayed closure or larger-than-normal fontanel size occurs with hydrocephalus, down syndrome, hypothyroidism or ricketts. a small fontanel is a sign of microcephaly as is early closure. 

the infant can turn the head side to side by 2 weeks 

when supine and the head is turned to one side 

(extension of same arm and leg, flexion of opposite arm and leg)

the tonic neck reflex disappears between 3 and 4 months and then the head is maintained in the midline. head controlled achieved by 4 months, when the baby can hold the head erect and steady when pulled to a vertical position

Percussion: with an infant you may directly percuss with your plexor finger against the head surface. This yields a resonant or "cracked pot" sounds, which is normal before closure of the fontanels

Auscultation: bruits are common in the skull in children younger than 4 or 5 years or in children with anemia. they are systolic or continuous and are heard over the temporal area. 

headache of musculoskeletal origin; may be a mild-to-moderate, less disabling form of a migraine 

• usually both sides, across frontal, temporal, and or occipital region of head: forehead, sides, and back of the head
• its a band like tightness, viselike, non throbbing, nonpulsatile
• gradual onset, last 30 minutes to days
• diffuse, dull thing pain mild to moderate
• in response to overwork or posture
• trigger can be stress anxiety, depression
• not worsened by physical activity

Headache of genetically transmitted vascular origin; headache plus program, aura, other symptoms

• commonly one-sided but can be both
• pain of often behind eyes, temple, forehead
• throbbing, pulsating
• rapid onset, pears 1-2 hr, lasts 4-72 hr, sometimes longer, moderate to severe pain
• 2 per month, last 1-3 days 1 in 10 patients have weekly headaches
• hormonal fluctuations (premenstrual), food, hunger, stress

headache that is intermittent excruciating, unilateral, with automatic signs

• always one sided, often behind or around the eye, temple, forehead, cheek
• continuous, burning, piercing, excruciating
• abrupt onset, peaks in minutes last 45-90 min
• can occur multiple times in one day in clusters, stabbing pain
• exacerbated by alcohol, street, daytime napping, wind or heat exposure

obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head. the face looks small compared with the enlarged cranium,

increasing pressure also produces dilated scalp veins, frontal bossing, and downcast or setting sun eyes

the cranial bones thin, suture separate and percussion yields a "cracked pot" sound

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Plagiocephaly

premature closing of one or multiple cranial sutures results in a malformed head and cosmetic deformity. mechanisms involve genetic mutation coding structural proteins or growth factor receptors,

sever deformities cannot contain the brain, eyes and optic nerves inside the cranial vault, and hypoplasia of the face results, warranting surgery

alcohol is a teratogenic to the developing fetus in severe cognitive and psychosocial impairment and changes in facial and brain structure. 

narrow palpebral fissures, mid facial hypoplasia, these malformations may be recognized at birth but more so during childhood.

a hematoma in one sternomastoid muscle, probably injured by intrauterine malposition, results in health tilt to one side and limited ROM to the opposite side. 

you feel a firm discrete contender mass in mid-muscle on the involved side.

goiter, a chronic enlargement of the thyroid gland, is common in wide regions of the world (especially mountainous regions) where the soil is low in iodine. 

iodine is an essential element in the formation of thyroid hormones

multiple nodules usually indicate inflammation or a multi nodular goiter rather than a neoplasm. 

increase production of thyroid hormones causes an increased metabolic rate, just like ramping up the furnace. 

nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. signs include forceful tachycardia; shortness of breath; excessive sweating; fine muscle tremor; thin silky hair; warm, moist skin; infrequent blinking; and a staring appearance 

Myxedema (hypothyroidism)

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a deficiency of a thyroid hormone means that the thyroid furnace is cold. this reduces the metabolic rate and when severe, causes non pitting edema or myxedema. 

usually called Hashimoto thyroiditis. symptoms include fatigue, cold intolerance, puffy, edematous face, puffy hands and feet

Acromegaly

a lower motor neuron lesion (peripheral), producing rapid onset of cranial nerve VII paralysis of facial muscles; almost always unilateral. This may be a reactivation go herpes simplex virus (HSV-1) that has been latent since child hood.

notice complete paralysis on one side of the face, the condition is improved with corticosteroids are given within 72 hours of onset

upper motor neuron lesion (central). a stroke is an acute neurologic deficit caused by blood clot of a cerebral vessel, as in atherosclerosis (ischemic stroke) or a rupture in a cerebral vessel (hemorrhagic stroke). 

if you suspect a stroke ask the person to smile

accompanies chronic wasting diseases such as cancer, dehydration and starvation.

features include sunken eyes; hollow cheeks; and exhausted, defeated expression