Presentation
Diffuse head swelling.
Patient Data
Large subgalal hematoma showing different blood densities denoting recurrent bleeding episodes. Also posterior linear calcifications.
No skull fractures.
Diffuse brain atrophic changes are noted.
Case Discussion
This is a known case of cerebral palsy with recurrent diffuse head and forehead swelling with no history of head trauma.
The patient was admitted to the hospital and had coagulation tests which were positive for coagulopathy. The patient received three units of fresh frozen plasma (FFP) transfusions. A pressure bandage was applied to the scalp and forehead. When the coagulation tests returned to normal range, the hematoma resolved. The patient was then referred to the hematological clinic for further evaluation of his coagulation state.
Subgaleal hematoma is a potentially life-threatening extracranial bleed. It's usually caused by head trauma involving tangential or radial forces applied to the scalp causing emissary veins traversing the subgaleal space to be ruptured. Large subgaleal hematoma in non-trauma setting or secondary to trivial head trauma should raise suspicion of coagulapathy/bleeding tendency. 1
Subgaleal hematomas usually do not require aspiration and drainage, because the risk of introducing infection outweighs the benefit of the procedure, its natural course is usually spontaneous resolution in a few days or weeks without complication. 1