Proptosis After Hair Pulling

Abstract

We describe proptosis due to a subperiosteal orbital hematoma that originated from a subgaleal bleed caused by hair pulling. A 13-year-old boy presented with a one-week history of progressive proptosis after his older sister pulled his hair during an argument. Computerized tomography showed a subgaleal hematoma and a right superior subperiosteal orbital hematoma. Progressive proptosis and compressive optic neuropathy developed, necessitating surgical evacuation with a favorable outcome.Hair pulling can result in a subgaleal bleed with extension to the orbital subperiosteal space. When managing patients with a subgaleal hematoma, this vision-threatening complication should be considered and treated accordingly.

An ectocranial lesion on the middle Pleistocene human cranium from Hulu Cave, Nanjing, China

“…In such cases, the pericranium is not directly impacted, but a large subgaleal hematoma can occur (Yip et al, 2003;Seifert and Pü schel, 2006).…”

“…Less clear is the distinct limitation of the lesion at the supratoral sulcus, since the loose subaponeurotic tissue should extend to the orbits, assuming that its attachments in Middle Pleistocene Homo with large supraorbital tori were the same as in recent humans. Subgaleal hematomas in modern humans are known to expand into the orbits and produce ocular abnormalities (Pope-Pegram and Hamill, 1986;Yip et al, 2003;Seifert and Pü schel, 2006).…”

Ocular involvement after subgaleal hematoma

“…17 No bleeding anomaly was found in our patient. Other reported associations include sickle cell disease, vitamin C deficiency, 6 hypertension, 13 and thrombocytopenia secondary to congenital heart disease. 18 Child abuse should be considered when evaluating SGH.…”

“…[6][7][8] Several authors believe their use contributes to the progression of the hemorrhage. 6-8 However, with no controlled studies and the use of these medications so common, their true role is hard to ascertain.…”

A Rare Cause of Subgaleal Hematoma in Children: Hair Pulling

“…[1][2][3][4][5] This condition is usually secondary to minor head trauma and an interesting mechanism of injury is hair pulling. 3,4,[6][7][8] In spite of its benign course, subgaleal hematomas may complicate by vision or lifethreatening events. 6,[8][9][10][11] In this paper, we present a case of uncomplicated SGH after hair pulling and aimed to describe its pathogenesis and management.…”