Subgaleal hematoma presenting as a manifestation of Factor XIII deficiency

Abstract

Extracranial hematoma without significant head trauma is uncommon. We discuss a 9-year-old girl who presented with sudden head swelling, bilateral proptosis, extraocular muscle palsy, and progressive visual disturbance after hair braiding. The diagnosis of a large subgaleal hematoma with extension into the superior aspect of the orbits was made, requiring surgical drainage. Hematologic workup revealed an underlying Factor XIII deficiency.

A Rare Cause of Subgaleal Hematoma in Children: Hair Pulling

“…Scalp is an acronym for skin, connective tissue, aponeurosis, loose areolar tissue and periosteum. 4,6 SGH is located in loose areolar tissue, between galea aponeurotica and periosteum. 4,5 Loose areolar tissue includes a vast number of emissary veins that connects superficial scalp veins and subdural venous sinuses.…”

“…Caput succedaneum is not limited by suture lines like SGH, but it contains less amount of seroanguinous fluid as develops in the connective tissue of the scalp. 4,6,14 Although it is a clinical diagnosis, CT is useful for patients with suspicion of abuse or traumatic brain injury. 7,15 Besides this, SGH can be the first manifestation of underlying coagulopathy such as von Willebrand disease and factor XIII deficiency.…”

“…7,15 Besides this, SGH can be the first manifestation of underlying coagulopathy such as von Willebrand disease and factor XIII deficiency. 3,6,13 Therefore, physicians must be careful about history of easy bleeding or bruising and medications like salicylate. For the laboratory evaluation, Raffini and Tsarouhas 3 suggested that complete blood count, prothrombin time and partial thromboplastin time are sufficient.…”

“…Treatment with aspiration and compressive bandage or surgical drainage has been reported in complicated hematoma. 3,4,6,9,12 On the other hand, some authors suggested that invasive treatment is required only for extended or infected hematoma, hemodynamic instability, dural sinus injury or uncertain diagnosis of SGH suspicion of differential diagnosis on account of the fact that invasive procedures increase the infection risk.…”

“…[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.…”