A 7-year-old boy was referred for medical assessment as part of the process of producing a statement of special educational needs. There had been no medical concerns in the past and there was no family history of note. On examination, the boy was noted to be micro cephalic with head circumference on the 0.4^th centile, while his height and weight were on the 50^th centile. Neurological examination was normal. Should this boy be referred for an MRI scan of the brain?

Oh dear, I think I’m turning into a radiologist. “And what …” my mind is crying “will you do differently after I scan your child?” Perhaps I had to visit too many small dark rooms when I was a House Officer (*).

[Edit – May 2008]

Well, there is an answer of sorts … The summary of the literature surrounding this (by Dr Ambika Karthikeyan) found only three papers, all of poor quality, and none of them suggested any useful yield of diagnostic information. Unless we have a specific indication for scanning (or a study is conceived and open in your centre) then “no” to MRI seems like the right answer.

Acknowledgement
Image from Wikipedia

* – House Officer. {Archaic} Pre 2000 AD, an almost-qualified doctor who assessed patients, initiated investigations and formulated clinical management plans.