Drs Simon and Simon bring up a point that we considered when we described our patient. While it seems likely that expansion of the subarachnoid space accounts for the bulging fontanel in infants with meningitis, other disease processes might produce this sign by very different mechanisms. Because most infants who present with a bulging fontanel are subjected to computed tomography or magnetic resonance imaging, this question will be easily resolved if an imaging plane includes the fontanel. We hope our short article encourages physicians to pay more attention to this in the future.
Rothman SM, Lee BCP. Bulging Anterior Fontanel—Reply. Arch Pediatr Adolesc Med. 1998;152(6):608. doi: