Subgaleal hemorrhage may initially be mistaken for caput succedaneum because blood crosses cranial suture lines in both conditions, but subgaleal hemorrhage, in contrast to cephalohematoma, is potentially life threatening. The blow breaks small blood vessels, releasing blood in the skin and fatty tissue under the skin. The authors present a novel technique for the management of chronic subdural haematoma which is a variation of a closed drainage system. It is a located between the periosteum and the scalp galea aponeurotica with the subgaleal space extending from the orbital ridges to the nuchal ridge with lateral confinement to the temporal fascia. Childhood subgaleal hematoma following minor head trauma. Subgaleal hematoma is caused by rupture of emissary veins and is typically seen in neonates after vacuum delivery 1, 2. A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain.
Subgaleal drain for chronic subdural hematoma the use of subdural drains after surgical evacuation of chronic subdural hematoma csh decreases the risk of recurrence and has become the standard of care. Subgaleal hemorrhages are caused by trauma to the head during labor and delivery, which results in the severing of emissary veins, located between the dural sinuses that cover the skull and the scalp 1. Mostly head trauma occurs due to the use of vacuum suction pump during the delivery of infants. A subgaleal haematoma is a collection of blood between the periosteum and the galea aponeurotica covering the neurocranium underneath the occipitofrontalis muscle.
Subgaleal hematoma describes scalp bleeding in the potential space between the periosteum and the galea aponeurosis. Massive subgaleal hematoma following minor head trauma. Subgaleal haemorrhage sgh detection and management in the newborn page 2 of 6 neonatal guideline risk factors vacuum extraction. Most commonly, this trauma is caused by the pulling, dragging, or compressing of a babys head through the. Subgaleal hematoma symptoms, causes, radiology, trauma. Neonatal subgaleal haemorrhage practice recommendation.
When seen in the emergency department, the child was felt to be otherwise well and hemodynamically stable and was discharged with close followup. As noted previously, a cephalohematoma does not cross suture lines, whereas the other two may. Hemorrhage into the subgaleal space resulted most likely from either radial or. A case of nontraumatic subgaleal hematoma effectively. The initial ct scan of head is abnormal in approximately 8% cases and depicts lesion requiring neurosurgical intervention in 0. Epidemiology moderate to severe presentations occur in 1. Moderate to severe subgaleal hematomas occur in 3010,000 live births. Diferencias entre cefalohematoma y caput succedaneum. Subgaleal hematoma symptoms, causes, radiology, trauma, treatment health care it is a condition in which blood starts flowing between 2 outer membranes of brain and these membranes are periosteum of skull and the.
Subgaleal hematoma sgh, an abnormal accumulation of blood under the galeal aponeurosis of the scalp, is more commonly observed in newborns and. This page includes the following topics and synonyms. Extension of a subgaleal hematoma resulting from blunt head tra urna into one orbit to cause a large subperiosteal orbital hematoma and permanent blindness of the involved eye in the unusual case. It is highly recommended that the color version of these photographs be looked at for clearer visualization of this hematoma. Seram 2014 s1122 colecciones extracraneales en pediatria.
Anatomia del escalpe esta compuesto por 2 planos anatomicos. Subgaleal hematoma do not show symptoms the very next day of trauma, it took 7 to 8 days to appear. The subaponeurotic space is a potential space extending anteriorly to the orbital margins, posteriorly to the nuchal ridge, and laterally to the temporal fascia, and this space. Case report we report on a previously healthy 19monthold patient who presented with an extensive subgaleal hematoma and significant anemia secondary to a fall. Introduction a subgaleal hematoma or subaponeurotic hemorrhage occurs infrequently and is usually seen in pediatric patients, especially in the neonatal period. After evacuation of the haematoma through a single. The clinical characteristics and prognosis of subgaleal. Subgaleal hematoma in a child, without skull fracture.
The subgaleal space is a layer consisting of loose connective tissue covering the entire cranial vault. Subgaleal hematoma at the contralateral side of scalp. Then irrigation of the hematoma cavity with sterile saline at 37oc was made until clear fluid came out of the burr hole. The ct scan findings in mtbi in decreasing order are. A 10 f drainage tube was placed in the subgaleal area and the terminal end of the tube was positioned over the burr hole in group i figure 1. Preoperative images of left frontal subgaleal hematoma left lateral and anterior profiles and noncontrast computed tomography scans showing large left frontal subgaleal hematoma extending down over ipsilateral orbit. Bruisehematoma the student health provider has treated you today for a bruise or hematoma. Subgaleal hematoma at the contralateral side of scalp trauma.
The patient was successfully treated by embolization of the superficial temporal artery. Subgaleal haemorrhage sgh detection and management in. Pdf a 14yold boy presented to authors emergency department ed with a fluctuant boggy mass over the scalp after minor traumatic brain injury. A case of apparently spontaneous subgaleal hematoma is reported which was associated with a qualitative platelet defect and not with trauma. Blood accumulates between the epicranial aponeurosis of the scalp and the periosteum. Learning point subgaleal hematomas are more common after assisted deliveries such as forceps and vacuum. B the haematoma lies superficial to the skull and underneath the aponeurosis and crosses the suture lines. Subdural versus subgaleal drainage for chronic subdural.
These six children had no evidence of fracture or abnormality of coagulation. Escalpe, hematoma subgaleal y fractura deprimida 1. Case report extension of tardive subgaleal hematoma into the. Many methods of treatment have been reported, each with its own advantages and disadvantages. Rupture of these veins results in bleeding into the space between the galea aponeurotica and the periosteum, the subgaleal space. This subgaleal space is not limited by sutures access a pdf of the full guideline here. Dec 01, 2008 subgaleal hematomas may be ballotable and have a fluid wave. This retrospective case series aimed to determine perinatal factors associated with. The sgh was aspirated once more in our ward, and the scalp was fixed by compression with an elastic bandage on the patients head. Posttraumatic subgaleal hematoma extending into the orbit. Massive traumatic subgaleal haematoma emergency medicine. Sgh is often preceded by a difficult vacuum extraction with either incorrect positioning of the cup, prolonged extraction time 20 minutes, 3 pulls or 2 cup detachments or failed vacuum extraction. Additionally, subgaleal hematoma has a high frequency of occurrence of associated head trauma 40%, such as intracranial hemorrhage or skull fracture. Subgaleal hematoma is defined as blood collection within the loose areolar tissue of the scalp.
Early recognition of this injury is crucial for survival. Case report extension of tardive subgaleal hematoma into the orbit causing blindness of both eyes. The major cause of subgaleal hematoma in children is minor head trauma. Subgaleal hematoma sgh, an abnormal accumulation of blood under the galeal aponeurosis of the scalp, is more commonly observed in newborns and children. As trauma is considered the major cause behind subgaleal hematoma. A 23monthold child developed massive head swelling secondary to a subgaleal hematoma several days following minor head trauma. Chronic subdural haematoma is one of the most common entities encountered in daily practice. Subgaleal hematoma symptoms, causes, radiology, trauma, treatment. Pdf comparison of subgaleal and subdural closed drainage. Subgaleal hematoma must be differentiated from subgaleal infection and air from frontal sinusitis with bony erosion, and from an encephalocele or tumor erosion through the skull. Halfway through the controlled, randomized toscan randomized trial of followup ct after evacuation of chronic subdural hematoma trial, the authors institutional guidelines changed to. Subgaleal hemorrhage sgh is an accumulation of blood in the space between the epicranial aponeurosis and the periosteum, caused by the rupture of the emissary veins. Of the 361 patients included in the analysis, 214 were stratified into cohort a subdural drainage recommended, while 147 were stratified into cohort b subgaleal drainage recommended.
However, the swelling recurred, and the patient was referred to our department on august 29. According to previous cases, the etiology of sgh includes mild head trauma, vacuumassisted vaginal delivery, contusion, and hair braiding or pulling. We analysed the case records of those who had a delayed presentation with subgaleal haematoma, as defined as more than 24 hours after the injury, or where no injury was recalled. The occurrence of these features does not correlate significantly with the severity of subgaleal hemorrhage. Table 5 from comparison of subgaleal and subdural closed. An approximately 40 ml hematoma was aspirated and the scalp swelling disappeared. Debemos descartar lesiones cerebrales o vasculares secundarias.
Inicio imagen diagnostica hematoma subgaleal difuso issn. Subgaleal hematoma developed one to eight days after minor head trauma in four children and in two infants, one with presumed trauma. Subgaleal hemorrhage is a rare but potentially lethal condition found in newborns. Mild traumatic brain injuries in adults pubmed central pmc. Continuous subgaleal suction drainage for the treatment of. A bruise is a discoloration of the skin caused by a blow. Subgaleal hematoma sgh is a wellknown condition in neonates especially after prolonged or instrumental delivery, but it has been rarely reported in childhood. Hematoma subgaleal difuso imagen diagnostica elsevier. Comparison of subgaleal and subdural closed drainage. We present a case of refractory nontraumatic subgaleal hematoma occurring in a 15yearold male patient.