Presentation
History of falling one day previously, followed by headache, altered mental status, and scalp swelling. No vomiting, loss of consciousness or seizures.
Patient Data
Large subgaleal hematoma without any underlying calvarial fracture. No recent intracranial hemorrhage, mass effect or midline shift. Old ischemic insult in the left cerebral hemisphere with ex vacuo dilatation of ipsilateral lateral ventricle. Incidental finding of parietal foramina.
Interval progression of previously noted subgaleal hematoma with bilateral orbital subperiosteal extension resulting in proptosis.
Marked interval improvement in the subgaleal hematoma, leaving behind a small residue. Complete interval resolution of bilateral proptosis.
Case Discussion
Known case of complex cyanotic congenital heart disease (ASD/PDA/D-TGA/VSD/double inlet left ventricle). Status post Glenn and Fontan procedures.
There is also a history of heterozygous prothrombin (factor II) mutation and recurrent ischemic strokes (partial left MCA & ACA territories). On permanent enoxaparin treatment.
Enoxaparin was discontinued for one week; otherwise, the subgaleal hematoma was managed conservatively. Follow-up study showed complete resolution of proptosis and marked resolution of subgaleal hematoma.
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