development or migration, usually genetic, chromosomal, or environmental) and secondary microcephaly (caused by a late insult to a normally developed brain, including hypoxia, ischemia, infection, trauma, or metabolic disorders) ( Table 96.2 ) Patients present at a mean age of to months with neurodevelopmental delays (65%) and acute seizure disorder (43%) Seizures may be recurrent and difficult to control History and physical examination are able to determine causality in only one-third of cases History of prematurity, perinatal history of maternal infection, congenital infection, drug and alcohol abuse, environmental exposures, family history of metabolic or genetic diseases, and birth data relating to possible anoxic injury may be of help A thorough neurologic examination is warranted Management of microcephaly usually requires a multidisciplinary approach Control of acute seizures and referral to pediatric neurologist is recommended Specific testing, for example, MRI, audiology, metabolic and genetic testing (karyotype, chromosomal microarray, chromosomal breakage analysis, and sequencing) can then be done