A parietal bone fracture with subgaleal and subdural hemorrhage in association with vacuum extraction delivery

Marchini, Giovanna; Muñoz, Daniel Martín; Stjernholm, Ylva Vladic

doi:10.1002/ccr3.2119

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…On the contrary, it is an extremely rare entity in the adult population and usually associated with severe head trauma and skull base fractures, coagulation disorders and traumatic or abusive hair pulling. 1,[3][4][5] In our case, a 62-year-old man receiving treatment with apixaban developed a massive subgaleal hemorrhage expanded to the orbital and neck subcutaneous tissue, several hours following blunt head trauma. To our knowledge, this is the first case of massive subgaleal hematoma in a patient after mild head trauma with no other concomitant bleeding risk factors than the anticoagulant treatment with apixaban.…”

Section: Introductionmentioning

confidence: 74%

“…Secondly, after blunt head trauma, these veins can bleed and/or cause subgaleal hematoma. 1,2,[4][5][6][7] Subgaleal hematoma refers to hemorrhage in the space between the galea aponeurotica and the periosteum. There are normal anatomic boundaries that limit the spread of pathological processes, such as infections or hematomas, from the scalp to the neck.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are cases in which a large hematoma under pressure may transgress these normal anatomic boundaries and may spread beneath the entire scalp and even dissect into the subcutaneous tissue of the neck and cause diffuse facial and neck edema such as in our case, and, in extremely rare cases, airway obstruction and emergency tracheostomy. 1,4,6,7 On the other hand, the frontalis muscle attaches only to the skin and subcutaneous tissue anteriorly and not to the frontal bone. As a result, there is no muscle attachment limiting the anterior spread of hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…5 Differential diagnosis includes cephalohematoma and caput succedaneum. 4 Its occurrence, except in the neonatal period, is extremely unusual and frequently associated with severe head trauma and skull base fractures involving tangential and radial forces to the head. In some rare reported cases, subgaleal hematoma has been described as a direct consequence of hair pulling.…”

Section: Discussionmentioning

confidence: 99%

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Massive subgaleal hematoma in a 62-year-old man treated with apixaban as a consequence of mild head trauma

Pagkou¹,

Papavramidis²,

Mavropoulou³

et al. 2021

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Subgaleal hematoma, accumulation of blood in the loose areolar tissue of the subgaleal space of the skull, is considered the most catastrophic complication of instrumental delivery. It is a rare finding in older ages, usually associated with coagulation disorders, severe head trauma leading to skull base fractures and accidental or abusive hair pulling. Complications include periorbital necrotising fasciitis, permanent blindness, infections and, in extreme rare cases, airway obstruction. Most cases of subgaleal hematoma resolve spontaneously, without the need of aspiration or drainage. We present here the case of a 62-year-old male on anticoagulant therapy with apixaban for chronic atrial fibrillation, who came to the emergency department after a car accident suffering from mild head trauma. The patient was complaining of a diffuse headache and physical examination showed a large ecchymosis and edema on the frontal area of the head. His neurological examination was unremarkable. Full-body computed tomography (CT) revealed a fracture of the third right rib. Twelve hours after admission, due to an excessive decrease of hematocrit, a second CT was performed. Although the images didn’t show intracranial hemorrhage or skull base fractures, a large and diffuse hematoma of the subaponeurotic space was observed and the diagnosis of subgaleal hematoma was confirmed. Massive subgaleal hematoma after mild head trauma is rather infrequent. Early diagnosis improves outcomes and can avert serious complications. Therapeutic strategy should be based on the severity of each case. In our case, conservative treatment appeared to be a valid alternative to surgery, as hematoma resolved spontaneously within 10 days. It is noteworthy that the use of anticoagulation is the only evident factor that could have been the precipitating factor for the development of the hematoma in our patient.

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Section: Introductionmentioning

confidence: 74%