EC Neurology

Subgaleal hematomas (SGH) are rare accumulations of blood between the galea aponeurotica and the periosteum, often resulting from minor head trauma. These hematomas are usually self-limiting and localized but can occasionally extend into the orbital region, causing significant complications such as proptosis, vision impairment, and ophthalmoplegia. Orbital subperiosteal hematomas (OSPH) are uncommon and require prompt diagnosis and differentiation from other orbital pathologies, including cellulitis and tumors. Computed tomography (CT) is the imaging modality of choice, offering rapid and detailed visualization of hematoma extent and orbital involvement. While conservative management is adequate for minor cases, surgical intervention is necessary for large hematomas to prevent severe complications, such as optic neuropathy or corneal damage. A multidisciplinary approach is critical to achieving favorable outcomes in these cases.

We report the case of a 6-year-old boy presenting with progressive diffuse scalp swelling and left-sided proptosis one week after a minor fall. Examination revealed tender scalp swelling and conjunctival chemosis, with preserved visual acuity. CT imaging identified a large subgaleal hematoma with orbital extension, displacing the eyeball inferiorly without fractures. Surgical evacuation removed 200 mL of subgaleal blood and 7 mL of orbital clots. The procedure was uneventful, and the patient experienced complete symptom resolution.

This case underscores the need for early detection and intervention in pediatric SGH with orbital involvement, as timely management can prevent permanent vision loss.

 Keywords: Subgaleal Hematomas (SGH); Orbital Subperiosteal Hematomas (OSPH); Computed Tomography (CT); Trauma

1. Jenkins TL., et al. “Orbital compartment syndrome following post-traumatic subgaleal hematoma”. Ophthalmic Plastic and Reconstructive Surgery 2 (2017): e33‑e36.
2. Puri S., et al. “Hairpulling causing vision loss: a case report”. Orbit (Amsterdam, Netherlands) 2 (2019): 162‑165.
3. Karcioglu ZA., et al. “Ocular involvement after subgaleal hematoma”. Journal of the American Association for Pediatric Ophthalmology and Strabismus 5 (2008): 521‑523.
4. Natarajan MS., et al. “Posttraumatic subgaleal and orbital hematoma due to factor XIII deficiency”. Journal of Neurosurgery: Pediatrics 2 (2011): 213‑217.
5. Bowens JP and Liker K. “Subgaleal hemorrhage secondary to child physical abuse in a 4-year-old boy”. Pediatric Emergency Care 12 (2021): e1738-e1740.
6. Scheier E., et al. “Subgaleal hematoma from a carnival costume”. Israel Medical Association Journal 6 (2019): 422-423.
7. Patchana T., et al. “Subgaleal hematoma evacuation in a pediatric patient: A case report and review of the literature”. Surgical Neurology International 11 (2020): 243.
8. Edmondson SJ., et al. “Hair today scalped tomorrow: massive subgaleal haematoma following sudden hair pulling in an adolescent in the absence of haematological abnormality or skull fracture”. Journal of Craniofacial Surgery 5 (2016): 1261-1262.
9. De Vito A and Mankad K. “Our experience of subgaleal haematoma due to hair pulling”. Acta Paediatrica 2 (2020): 427.
10. Jenkins TL., et al. “Orbital compartment syndrome following post-traumatic subgaleal hematoma”. Ophthalmic Plastic and Reconstructive Surgery 2 (2017): e33-e36.