Subgaleal Hemorrhage: Symptoms and Treatment

Subgaleal hemorrhage is a significant medical condition characterized by bleeding into the potential space between the periosteum and the galea aponeurotica, which is the connective tissue layer of the scalp.

While relatively rare, subgaleal hemorrhage can have serious implications for both short-term and long-term health. In infants, this condition can lead to severe complications due to the potential for rapid blood loss and resulting anemia.

The impact of untreated subgaleal hemorrhage can affect essential functions like oxygenation, circulation, and neurological well-being.

In its early stages, subgaleal hemorrhage may be asymptomatic, making early detection crucial. Regular screenings are essential to prevent potential complications. Untreated subgaleal hemorrhage can result in long-term health risks, including anemia, neurological deficits, and developmental delays.

Therefore, raising awareness about this condition and promoting early intervention are vital to improve outcomes.

Causes of Subgaleal Hemorrhage

The causes of subgaleal hemorrhage can vary, with several factors contributing to the development of this condition. Understanding these causes is essential for effective management and prevention.

Primary Causes

• Trauma during Childbirth: Trauma during delivery, such as the use of vacuum extraction or forceps, can lead to subgaleal hemorrhage. The mechanical forces exerted on the infant's head can cause blood vessels to rupture, resulting in bleeding within the subgaleal space.
• Coagulopathies: Conditions that affect blood clotting, such as hemophilia or von Willebrand disease, can predispose individuals to subgaleal hemorrhage. Impaired coagulation mechanisms increase the risk of spontaneous bleeding into the subgaleal space.
• Birth Injuries: Injuries sustained during the birthing process, such as skull fractures or head trauma, can also result in subgaleal hemorrhage. These injuries may occur due to prolonged labor, macrosomia (large birth weight), or malpresentation of the fetus.
• Birth Trauma: Excessive force or pressure applied to the infant's head during delivery can cause subgaleal hemorrhage. Factors such as rapid descent or improper positioning of the fetus can contribute to the development of this condition.

Secondary risk factors or lifestyle contributors can also play a role in the occurrence of subgaleal hemorrhage. These factors include maternal hypertension, maternal use of anticoagulant medications, and maternal substance abuse.

Each of these secondary causes can further increase the likelihood of developing subgaleal hemorrhage.

Secondary Causes

• Maternal Hypertension: Maternal hypertension can lead to placental insufficiency, increasing the risk of fetal distress during delivery and subsequent subgaleal hemorrhage.
• Anticoagulant Medications: Maternal use of anticoagulant medications can affect the infant's coagulation status, potentially leading to bleeding disorders and an increased susceptibility to subgaleal hemorrhage.
• Maternal Substance Abuse: Substance abuse during pregnancy can have detrimental effects on fetal development, including an increased risk of birth injuries and associated complications like subgaleal hemorrhage.

Symptoms of Subgaleal Hemorrhage

Recognizing the symptoms of subgaleal hemorrhage is crucial for prompt diagnosis and treatment. Symptoms can vary depending on the stage of the condition, ranging from subtle early signs to more severe advanced manifestations.

Early Symptoms

• Swelling of the Scalp: The early symptom of scalp swelling may be subtle initially but can progress rapidly. This swelling can cause discomfort and affect the infant's ability to move their head comfortably.
• Pallor or Jaundice: Pallor or jaundice may indicate anemia resulting from blood loss in subgaleal hemorrhage. These signs can impact the infant's energy levels and overall well-being.

Advanced Symptoms

• Hypovolemic Shock: Advanced stages of subgaleal hemorrhage can lead to hypovolemic shock, characterized by rapid heart rate, low blood pressure, and decreased urine output. This condition requires immediate medical attention to prevent life-threatening complications.
• Neurological Deficits: Severe subgaleal hemorrhage can result in neurological deficits, such as seizures or altered mental status. These symptoms can have long-term implications for the infant's cognitive and developmental outcomes.

Diagnosis of Subgaleal Hemorrhage

Diagnosing subgaleal hemorrhage involves a comprehensive evaluation to confirm the presence of bleeding in the subgaleal space. Various diagnostic tests are utilized to assess the extent of hemorrhage and guide appropriate management strategies.

• Ultrasound Imaging: Ultrasound imaging is a non-invasive diagnostic tool that can visualize the subgaleal space and identify the presence of hemorrhage. This test provides real-time imaging of the affected area and helps in determining the extent of bleeding.
• Complete Blood Count (CBC): A complete blood count is essential for assessing the infant's hemoglobin levels and detecting anemia associated with subgaleal hemorrhage. Abnormalities in red blood cell counts can indicate ongoing bleeding and the need for intervention.
• Coagulation Studies: Coagulation studies, including prothrombin time (PT) and activated partial thromboplastin time (aPTT), are performed to evaluate the infant's coagulation status. Abnormal results can suggest underlying coagulopathies contributing to subgaleal hemorrhage.
• Magnetic Resonance Imaging (MRI): In complex cases, magnetic resonance imaging may be utilized to visualize structural abnormalities or complications associated with subgaleal hemorrhage. MRI provides detailed imaging of soft tissues and can aid in treatment planning.

Treatment Options for Subgaleal Hemorrhage

The management of subgaleal hemorrhage focuses on addressing the underlying cause of bleeding, stabilizing the patient, and preventing complications. Treatment options may include a combination of medications, lifestyle modifications, and advanced interventions tailored to the individual's condition.

• Medications: Medications such as vitamin K may be administered to correct coagulation abnormalities and prevent further bleeding. In cases of severe anemia, blood transfusions may be necessary to restore adequate hemoglobin levels.
• Dietary Modifications: Dietary modifications may include promoting iron-rich foods to support hemoglobin production and replenish iron stores depleted by blood loss. Ensuring adequate nutrition is essential for recovery and overall well-being.
• Physical Activity: Engaging in appropriate physical activity can promote circulation, muscle strength, and overall recovery post-treatment. Physical therapy may be recommended to optimize functional outcomes and neurological development in affected individuals.