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Halim D, Faried A. Massive subgaleal hematoma: a potentially fatal rare entity-a case-based review. Childs Nerv Syst 2023; 39:1977-1983. [PMID: 36961585 DOI: 10.1007/s00381-023-05933-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Massive subgaleal hematoma is defined as profuse bleeding in the subgaleal layer of the scalp, causing excessive accumulation of hematoma, thus progressively increasing the size of head circumference. If not immediately diagnosed and managed carefully, continuous bleeding will lead to hematoma enlargement, impairing the functions of surrounding organ(s) and general homeostasis. In severe cases, subgaleal hematoma could lead to severe morbidity or even death. CASE REPORT We describe the case of an 11-year-old girl with a history of microcephaly and intellectual disability, presented with massive soft tissue swelling on more than half of her cranial circumference, accompanied with intermittent fever, anemia, and leukocytosis. The initial cerebral CT scan identified a mixed density extracranial lesion with multilobulated cystic appearance. The initial effort to aspirate the mass by a needle failed, and the patient was initially diagnosed with Pott's puffy tumor. Intraoperative findings confirmed the presence of massive subgaleal hematoma, and complete removal of the hematoma was achieved. The post-surgical period was uneventful, and the patient was discharged without any complications. CONCLUSION Massive subgaleal hematoma should be considered in cases where children's head circumference increases rapidly, with or without a clear history of trauma and the presence of any possible risk factors. Missed diagnosis and inappropriate therapy could lead to unfavorable outcome. Hence, it is important for any clinicians to be familiar with this entity, so timely diagnosis and treatment can be made.
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Affiliation(s)
- Danny Halim
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, West Java, Indonesia
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, West Java, Indonesia.
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Aubert B, Cadoux M, Sahyoun C. Traumatic subgaleal hematoma drainage in an adolescent: a case report and review of the literature. Front Pediatr 2023; 11:1182899. [PMID: 37325363 PMCID: PMC10266201 DOI: 10.3389/fped.2023.1182899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Subgaleal hematoma is a well-known life-threatening complication of instrumentation at birth. Even though most cases of subgaleal hematomas occur in the neonatal period, older children and adults are also at risk for subgaleal hematomas and their complications, following head trauma. Objective We hereby report the case of a 14-year-old boy who presented with a traumatic subgaleal hematoma requiring drainage and review the relevant literature regarding potential complications and indications for surgical intervention. Results Infection, airway compression, orbital compartment syndrome and anemia requiring transfusion are potential complications of subgaleal hematomas. Although rare, surgical drainage and embolization are occasionally required interventions. Conclusion Subgaleal hematomas following head trauma can occur in children beyond the neonatal period. Large hematomas may require drainage to relieve pain or when compressive or infectious complications are suspected. Although usually not life-threatening, physicians taking care of children must be cognizant of this entity when caring for a patient with a large hematoma following head trauma and in severe cases, consider a multidisciplinary approach.
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Matsumura K, Muto J, Tanaka M, Joko M, Yoshikawa T, Hirose Y. Usefulness of three-dimensional computed tomography venography differentiating calvarium subperiosteal hematoma crossing the suture lines due to hair pulling from subgaleal hematoma: case report and review of the literature. Childs Nerv Syst 2022; 38:2017-2020. [PMID: 35380260 DOI: 10.1007/s00381-022-05517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
This case showed a 13-year-old boy presented with calvarium subperiosteal hematoma crossing the suture lines caused by hair pulling, and 3D-CTV can differentiate calvarium subperiosteal hematoma crossing the suture lines from subgaleal hematoma. He was treated successfully.
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Affiliation(s)
- Kazuyasu Matsumura
- Department of Neurosurgery, Fujita Health University, Toyoake City, 1-98 Dengakugakubo, Kutsukake, Aichi, Japan
| | - Jun Muto
- Department of Neurosurgery, Fujita Health University, Toyoake City, 1-98 Dengakugakubo, Kutsukake, Aichi, Japan.
| | - Makito Tanaka
- Department of Pediatrics, Fujita Health University, Aichi, Japan
| | - Masahiro Joko
- Department of Neurosurgery, Fujita Health University, Toyoake City, 1-98 Dengakugakubo, Kutsukake, Aichi, Japan
| | | | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Toyoake City, 1-98 Dengakugakubo, Kutsukake, Aichi, Japan
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Patchana T, Ghanchi H, Taka T, Calayag M. Subgaleal hematoma evacuation in a pediatric patient: A case report and review of the literature. Surg Neurol Int 2020; 11:243. [PMID: 32905325 PMCID: PMC7468241 DOI: 10.25259/sni_207_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/01/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Subgaleal hematoma (SGH) is generally documented within the neonatal period and is rarely reported as a result of trauma or hair braiding in children. While rare, complications of SGH can result in ophthalmoplegia, proptosis, visual deficit, and corneal ulceration secondary to hematoma extension into the orbit. Although conservative treatment is preferential, expanding SGH should be aspirated to reduce complications associated with further expansion. Case Description: A 12-year-old African-American female with no recent history of trauma presented with a chief complaint of headache along with a 2-day history of enlarging 2–3 cm ballotable bilateral frontal mass. Hematological workup was negative. The patient’s family confirmed a long history of hair braiding. The patient was initially prescribed a period of observation but returned 1-week later with enlarging SGH, necessitating surgical aspiration. Conclusion: SGH is rare past the neonatal period, but can be found in pediatric and adolescent patients secondary to trauma or hair pulling. Standard workup includes evaluation of the patient’s hematological profile for bleeding or coagulation deficits, as well as evaluation for child abuse. Although most cases of SGH resolve spontaneously over the course of several weeks, close follow-up is recommended. The authors present a case of a 12-year-old female presenting with enlarging subgaleal hemorrhages who underwent surgical aspiration and drainage without recurrence. A literature review was also conducted with 32 pediatric cases identified, 20 of which were related to hair pulling, combing, or braiding. We review the clinical course, imaging characteristics, surgical management, as well as a review of the literature involving subgaleal hemorrhage in pediatric patients and hair pulling.
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Affiliation(s)
- Tye Patchana
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, United States
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, United States
| | - Taha Taka
- Department of Neurosurgery, University of California, Riverside School of Medicine, United States
| | - Mark Calayag
- Department of Neurosurgery, Kaiser Permanente, Fontana, California, United States
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Massive subgaleal hematoma seen together with idiopathic thrombocytopenic purpura (ITP): A case report and review - First case in the literature. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wajima D, Nakagawa I, Kotani Y, Wada T, Yokota H, Park YS, Kichikawa K, Nakase H. A case of refractory subgaleal hematoma in adolescence treated with aspiration and endovascular surgery. Acta Neurochir (Wien) 2017; 159:1565-1569. [PMID: 28484831 DOI: 10.1007/s00701-017-3207-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/25/2017] [Indexed: 11/28/2022]
Abstract
A 14-year-old boy experienced sudden headache in the left parietal region, without any history of head trauma. Approximately 40 ml of hematoma was aspirated using a 22-gauge needle, and scalp swelling immediately disappeared. However, the swelling recurred bilaterally 2 weeks later. Left external carotid angiography revealed a reticular shadow consistent with subgaleal hematoma from a branch of bilateral superficial temporal arteries, without any arteriovenous shunts. The patient was successfully treated using the combination of hematoma aspiration and embolization of the superficial temporal artery. The combination of aspiration of hematoma and embolization may be effective for refractory non-traumatic subgaleal hematoma.
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Affiliation(s)
- Daisuke Wajima
- Department of Neurosurgery, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan.
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Yukiko Kotani
- Department of Neurosurgery, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Takeshi Wada
- Department of Radiology, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Hiroshi Yokota
- Department of Neurosurgery, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan
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Orbital Compartment Syndrome Following Post-Traumatic Subgaleal Hematoma. Ophthalmic Plast Reconstr Surg 2017; 33:e33-e36. [PMID: 27046037 DOI: 10.1097/iop.0000000000000684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Orbital extension of subgaleal hematoma is rare. This report describes the case of an otherwise healthy 10-year-old girl who developed delayed contralateral proptosis and external ophthalmoplegia after relatively minor right-sided forehead trauma. She was found to have bilateral subgaleal hematomas communicating with a left superior subperiostial orbital hematoma. Over the course of 2 days, she developed an orbital compartment syndrome requiring emergent canthotomy and cantholysis, followed by surgical incision and drainage of her scalp hematoma without orbitotomy. Hematologic work-up revealed heterozygous factor VII deficiency.
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Mellick LB. Delayed forehead hematoma. Pediatr Emerg Care 2012; 28:830-3. [PMID: 22863832 DOI: 10.1097/pec.0b013e3182628b3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santín-Amo J, Gelabert-González M, Villa-Fernández J, Castro-Bouzas D, Serramito-García R, García-Allut A. Hematoma subgaleal crónico en un lactante. Presentación de un caso. Neurocirugia (Astur) 2011. [DOI: 10.1016/s1130-1473(11)70022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Koizumi K, Suzuki S, Utsuki S, Nakahara K, Niki J, Mabuchi I, Kurata A, Fujii K. A case of non-traumatic subgaleal hematoma effectively treated with endovascular surgery. Interv Neuroradiol 2010; 16:317-21. [PMID: 20977867 PMCID: PMC3278003 DOI: 10.1177/159101991001600315] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 06/02/2010] [Indexed: 11/16/2022] Open
Abstract
Non-traumatic subgaleal hematoma is very rare. We present a case of refractory non-traumatic subgaleal hematoma occurring in a 15-year-old male patient. The patient was successfully treated by embolization of the superficial temporal artery. This therapeutic approach to refractory non-traumatic subgaleal hematoma is discussed.
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Affiliation(s)
- K Koizumi
- Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan.
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Late onset subgaleal hemorrhage infection with Streptococcus pneumoniae? Eur J Pediatr 2009; 168:647-50. [PMID: 19165500 DOI: 10.1007/s00431-009-0922-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
We report a case of an infected subgaleal hematoma caused by an unusual micro-organism in a previously healthy 11-month-old girl. Our patient presented at the emergency department with an increasing scalp swelling for 2 weeks, and culture of the evacuated fluid yielded Streptococcus pneumoniae. Although she was born after vacuum delivery and a scalp swelling was noticed from the third day of life, this swelling disappeared completely at the age of 3 months. Parents were thoroughly questioned but we could not find out a new traumatic head event. We postulate that in our patient, a subgaleal hemorrhage developed after vacuum delivery and possibly infected 11 months later, presumably from hematogenous seeding of an acute otitis media. The patient recovered well after surgical drainage and antimicrobial therapy.
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Greco F, Fiumara A, Sorge G, Pavone L. Subgaleal hematoma in a child with Sturge-Weber syndrome: to prevent stroke-like episodes, is treatment with aspirin advisable? Childs Nerv Syst 2008; 24:1479-81. [PMID: 18575872 DOI: 10.1007/s00381-008-0662-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Indexed: 11/30/2022]
Abstract
CASE REPORT A subgaleal hematoma (SGH) occurred in a young patient with Sturge-Weber syndrome (SWS) who was treated with aspirin after a mild head trauma. MATERIALS AND METHODS A 4-year-old child with SWS, who was chronically treated with aspirin at an antiplatelet dosage of 3 mg/kg per day, presented with extensive SGH and significant anemia after a mild head trauma. RESULTS AND CONCLUSION It is conceivable that the minor head trauma and chronic use of aspirin caused the SGH. Based on this event, the chronic use of aspirin in young patients with SWS, as suggested to prevent stroke-like episodes, is disputable.
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Affiliation(s)
- Filippo Greco
- Department of Pediatrics, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
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Karcioglu ZA, Hoehn ME, Lin YPK, Walsh J. Ocular involvement after subgaleal hematoma. J AAPOS 2008; 12:521-3. [PMID: 18620880 DOI: 10.1016/j.jaapos.2008.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 11/28/2022]
Abstract
Subgaleal hemorrhage (SGH) is a known complication of both major and minor childhood head trauma. Rarely, it can be associated with intraorbital hemorrhage and ocular compromise. We report a child who presented with SGH and later developed orbital hemorrhages bilaterally with loss of vision necessitating surgical intervention. We also review the literature for this condition.
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Affiliation(s)
- Zeynel A Karcioglu
- Hamilton Eye Institute, UT Health Sciences Center, Memphis, Tennessee 38163, USA.
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