Macewen's sign / cracked pot sound

The sign was described by Sir William Macewen.
The test is performed by percussing on the skull of the patient and a cracked pot sound can be heard to the naked ears of the examiner brought closed to the skull.
This sound can be heard even better if percussion is done on one side while a stethoscope is placed on the other side.

A positive test is indicative of separated sutures. As long as the anterior fontanel is open i.e. up to 18 months, the test will be positive.
In pathological cases, it is due to a raised intracranial tension due to hydrocephalus or an abscess.

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