Microcephaly: Definition and Treatment Options

The Zika Virus has garnered a lot of attention recently due to concerns for pregnant mothers who contract the virus and the risk of microcephaly in their newborns.

Microcephaly (micro = small, cephaly = head) is defined as a small head size which can result from improper brain growth during pregnancy or cessation of brain growth after birth. In rare instances, it can result from pre-mature fusion of the skull bones; a condition called craniosynostosis. and can have a wide variety of clinical factors associated with it.

  • Infections during pregnancy
    • Cytomegalovirus
    • Rubella
    • Toxoplasmosis
    • Zika Virus (currently being investigated)
  • Malnutrition
  • Peri-natal exposure to alcohol and other toxins
  • Decreased blood supply to the brain (either in the uterus or after birth)
  • Rare craniosynostosis

Features that can be seen in conjunction with microcephaly:

  • Appearance of the baby’s head is very small
  • High-pitched cry
  • Poor feeding
  • Seizures
  • Increased movement of the arms and legs (spasticity)
  • Developmental delays
  • Intellectual disability

Conditions associated with microcephaly:

  • Developmental delay
  • Seizures
  • Language processing
  • Feeding problems
  • Sensory processing

Microcephaly can be diagnosed in two ways – either in utero or after birth. In utero diagnosis is based upon ultrasound imaging and measurements. After birth, a child’s primary care provider should be measuring the child’s head circumference while monitoring development. The Centers for Disease Control defines microcephaly as 2 standard deviations below the average values.   If child’s head meets the criteria for microcephaly, serial measurements every several months are typically warranted.

Children diagnosed with microcephaly typically require further imaging such as a cranial ultrasound or magnetic resonance imaging (MRI) to further evaluate any possible causes of the microcephaly.

Most cases of microcephaly do not have a cure. Instead, supportive measures like occupational, physical and speech therapy are often employed to assistwith development.   Some children require medical management for issues such as seizures.A small percentage of children will need feeding assistance with a feeding tube. For a child with craniosynostosis, surgery is frequently necessary to decrease the risk of increased intra-cranial pressure. If concerns exist for this situation, these children may require a CT scan and should be referred to a pediatric craniofacial surgeon for further evaluation and treatment.

Gregory D. Pearson, MD
Gregory D. Pearson, MD, is a member of the Cleft Palate/Craniofacial Team and also helps staff the Vascular Malformations Clinic at Nationwide Children’s Hospital and is an Assistant Professor of Clinical Plastic Surgery at The Ohio State University College of Medicine. Dr. Pearson sees patients in the Plastic Surgery Clinic located in the Outpatient Care Center at Nationwide Children’s. Along with members of the section of Neurosurgery, he now performs reconstruction of complex craniofacial anomalies at Nationwide Children’s Hospital.

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