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Z.U.M.J.Vol.18; N.6; November; 2012
Subgaleal Hematoma Secondary………….
SUBGALEAL HEMATOMA SECONDARY TO HAIR BRAIDING. CASE REPORT.
Mubarak Ali AlGahtany
Assistant professor of Neurosurgery Department of Surgery, King Khalid University . Abha. KSA.
ABSTRACT
A 11-year- old girl presented to our hospital with a big
subgaleal hematoma developed after hair braiding. To our
knowledge, this is the first case reported of a subgaleal hematoma without mild trauma, coagulation disorder or hair
pull.
Peripheral blood examination is normal ( total
leucocytic
count,11.7 X 109 / L , total red blood cells, 6.24 X
109 /L ,
hemoglobin , 14 gm%, and platelets , 458 X 109 /
L ).
The bleeding profile is normal ( prothrombin time
= 12 seconds ,the partial thromboplastin time = 33
seconds and international normalized ratio = 1.1).
Other laboratory investigation are also normal
with serum glucose 91 mg /dl, serum urea 23
mg/dl , serum creatinine 0.6 mg /dl, sodium 139
mg /dl , potassium 3.9 mg /dl and chlorid 106 mg
/dl.
CT scan of the head with and without contrast
showed a large bilateral subgaleal hematoma in
the upper vault of the skull with right side
predominance ( figure 1). There is no abnormal
enhancement,
intracranial
hemorrhage,
intracranial AVM or other lesions. No scalp AVM
and no skull fractures.
Patient was discharged home to be followed in
neurosurgery clinic and prior to discharge the
bleeding time was tested and found to be normal
and other blood samples extracted for further
investigation such as clotting time and liver
function tests. We advised for her to apply cold
fomentation on the scalp swelling. After two
weeks , the patient returned to clinic with
complete fading of the scalp swelling and results
of clotting time and liver function tests were with
normal range. CT scan of the head was repeated
and revealed complete recession of the subgaleal
hematoma.( figure2)
INTRODUCTION
any sources have described subgaleal
hematoma in the sitting of significant
trauma or blood coagulopathy diseases. Here we
present a rare case of the child with a significant
subgaleal hematoma secondary to hair braiding
without trauma or blood coagulopathy disorder.
CASE PRESENTATION
A 11- year- old Saudi girl presented to the
neurosurgery clinic in Asir Central Hospital ,
Abha, Saudi Arabia with a progressive scalp
swelling 9 days after hair braiding . she has no
history of any bites, major or minor trauma ,
recent drug intake , fever or bleeding tendency.
No history of any systemic disease. There is no
family history of a bleeding disorder. On clinical
examination , Vital signs are normal; blood
pressure 116/61, heart rate 93 bpm, temperature
37oC, oxygen saturation 98% on room air. She
looks well and healthy with no signs of pain or
distress. Neurologically she is fully conscious,
GCS 15/15 and pupils are normal size, equal and
reacting to light with normal fundi bilaterally.
Cranial nerves are normal and there is no focal
neurological deficit. Head examination revealed a
large soft painless swelling in the high parietal
area of the scalp mainly in the right side but
crossing over the midline to the left. The
overlying skin is normal, specifically no signs of
bite, trauma, burn, or inflammation.
Systemic examination revealed no signs of illness,
pallor or jaundice. No lymph nodes enlargements
or manifestations of bleeding tendency such as
purpura, bruising , echymosis , nose bleeds or
bleeding gums. The chest and abdominal
examination is normal.
M
AlGahtany M.
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Z.U.M.J.Vol.18; N.6; November; 2012
Subgaleal Hematoma Secondary………….
Figure1. Axial CT Scan of head with contrast showing large subgaleal hematoma surrounding most of high
parietal regions.
Figure2. Follow up plain CT scan showed recession of the subgaleal hematoma over two weeks .
AlGahtany M.
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Z.U.M.J.Vol.18; N.6; November; 2012
Subgaleal Hematoma Secondary………….
pediatric age group avoid unnecessary reporting to
child protective services.
To the best of our knowledge , this is the first case
to be reported with a large subgaleal hematoma in
a child caused by a hot stream of the hair braiding
without hair pulling or using tight rows of braids
and without a trauma or systemic diseases.
REFERENCES
DISCUSSION
The common cause of subgaleal hematoma is
traumatic. Most reported cases are neonates , the
reported incidence ranges; 1.6-3/1000 live births 1
. The risk factors are instrumental delivery ,
prolonged second stage of labor, precipitate labor
and prematurity 2 . Beyond the neonatal period the
subgaleal hematoma often develops after head
trauma (e.g fall down from high, direct blow to
the head , RTA , child abuse ..etc) involving
tangential or radial forces applied to the scalp
causing emissary veins traversing the subgaleal
space to rupture 3,14.
The spontaneous subgaleal hematoma is very rare.
It had been reported mostly in children and
specifically in ones with bleeding tendency like
those with vitamin K deficiency 4 , hemophilia 5,
factor XIII deficiency 6 , Von Willebrand disease
7
and acute myeloid leukemia 8 . Other reported
cases involved also children who had aggressive
hair treatment due to hair combing 9 , hair pulling
10
, hair braiding by tight rows of braids 3,7,11,13 .
Non traumatic subgaleal hematoma was reported
in association with aneurysm of superficial
temporal artery 12.
In our patient there is no history of trauma or
suspected child abuse according to history,
general examination and finding of CT Scan of
the head. There is no sign of purpura or
ecchymosis, the leucocyte cell count, hemoglobin,
liver function tests and coagulation profile are
normal. So we excluded any systemic or blood
coagulopathy disorder. In view of normal bleeding
and clotting times as well as normal PT an PTT,
investigations like Von Willebrand antigen and
bone marrow aspiration were not done .The
subgaleal hematoma developed in our patient after
applying hot stream during hair braiding without
hair pulling or applying tight rows of braids unlike
previously reported cases that linked SGH post
hair braiding to hair pulling or applying tight
rows. It started to resolve over two weeks without
intervention and without complication or
recurrence over one year of follow up.
CONCLUSION
Spontaneous subgaleal hematoma is rare and
mostly reported in child age group. In the absence
of bleeding disorders they resolve spontaneously
despite of their large size and require no specific
intervention.
Awareness of hair braiding as a cause of subgaleal
hematoma
helps
to
avoid
unnecessary
investigations and interventions as well as in
AlGahtany M.
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