An unusual aperture in a child's calvaria from western Central Asia: differential diagnoses

Abstract

The partial remains of a child's cranium were examined as part of a three-year research project investigating the health and population movements of prehistoric communities in western Central Asia. Differential diagnoses are provided for an unusual aperture observed at the bregma. Possible aetiologies for the aperture include congenital and developmental defects, pathological alterations, surgical intervention, trauma and post-mortem changes. The lesion presented in this article is interesting in terms of the contribution it makes to our understanding of the types of possible diseases that existed in the past, in this relatively understudied part of the world.

Probable Atretic Cephalocele in an Adult Female from Punta Secca (Sicily, Italy)

“…297–297). In addition, similar lesions have also been observed on a child between 2 and 4 years of age from northern Uzbekistan, dating to the fourth/third century bc (Blau, ); on a child aged between 6 and 8 years of ca ad 1000/1200 from Ancon, Peru (Stewart, ; Ortner, : p. 460; Aufderheide & Rodríguez‐Martín, : p. 59); and on a middle‐aged Native American female from New York of ad 1670/87 (Stewart, ). In all these cases, the defect is located at the bregma, the anatomical point at the top of the cranium where the parietal and frontal bones meet, and the size of the aperture ranges from approximately 18 to 22 mm.…”

A probable example of cranial dysraphism from New Orleans, Louisiana

“…The location of the perforations may indicate that some of these examples could be bregmatic dermoid cysts, but more likely, the majority of cases are cranial dysraphisms. Archaeological examples may not be able to obtain differentiation to such a specific degree (e.g., Blau, ; Sublett & Wray, ). The differential diagnosis indicates that while the majority of potential causes of the defect can be eliminated, a cyst or cranial dysraphism is the most likely condition.…”

“…The majority of the bioarchaeological literature identifies defects located at bregma as congenital herniations/dysraphisms (Gass, ; Ortner, ; Powell, ; Stewart, ; Webb & Thorne, ), although some lesions are more difficult to assess resulting in diagnoses that remain undifferentiated (Blau, ; Sublett & Wray, ). Only six examples of defects at bregma exist in the literature and consistent in each of these papers is the description of the shape, position, and location of the defect (Table ).…”

“…Overall, the defect on the juvenile skull is inconsistent in description with the other four examples as the defect does not interact with bregma but may be an effect of age and development. Blau () presents a possible case of cranial dysraphism from an archaeological site in Uzbekistan of a cranium from a 2.5–3.5 year‐old child. The perforation is located over bregma, obliterating the sutures.…”

“…Published reports regarding cranial lesions located at bregma are common, with several examples from around the world in both the bioarchaeological and clinical literature (Blau, ; Drolet, ; Drolet, Clowry, McTigue, & Esterly, ; Gass, ; Held, Rose, Hamm, & Fölster‐Holst, ; Ortner, ; Powell, ; Stewart, ; Sublett & Wray, ; Webb & Thorne, ). The bioarchaeological literature tends to identify a particular type of bregmatic lesion as cranial dysraphism.…”