Cephalohematoma
Epidemiology
A cephalohematoma is noted in ∼1%–2% of spontaneous vaginal deliveries and ∼3%–4% of forceps or vacuum-assisted deliveries.
The most common location is under the right parietal bone and may be associated with an underlying skull fracture. Resolution typically occurs without treatment by 3–4 months of age. Anemia and hyperbilirubinemia are common sequelae, but cephalohematomas rarely become spontaneously infected.
In 2013 there was the first report describing a possible association between parvovirus B19 infection and cephalhematoma. Parvovirus B19 infection should be considered in the differential diagnosis of children who present with unexplained hemorrhage such as cephalhematoma or petechiae 1).
Classification
Diagnosis
Right frontotemporoparietal intracranial acute epidural hematoma, up to 1 cm. thick, underlying a broad line of right temporoparietal Right parietal subgaleal hematoma, up to 1cm. of thickness.
Hemorrhage under the scalp
Not to confuse with subperiosteal hematoma.
Treatment
Surgical drainage of uncomplicated cephalohematomas is contraindicated because of the usually benign course, the propensity for reaccumulation with resultant hemodynamic instability, and the possibility of introducing microorganisms into a sterile space.
Complications
Anemia and hyperbilirubinemia.
Infection
Clinicians should be aware that cephalohematoma is a potential site of infection after fetal monitoring.
The incidence of associated system infection is high and may result in mortality. Appropriate diagnostic and therapeutic measures should be undertaken promptly if there are infectious signs 2).
A 30-day-old infant presenting a E. coli meningitis with recurrence 5 days after stopping antibiotics. The clinical investigations concluded to the diagnosis of osteomyelitis of the parietal bone probably as a consequence of the infection of a cephalohematoma due to a wound caused by a foetal monitoring. Cephalohematoma is frequent in infant and is usually without consequences. Though rare, cases of infected cephalohematomas are described in the literature, with possible complications of meningitis (E. coli) and osteomyelitis. Sometimes the both pathologies are associated. A secondary infection of cephalohematomas must be taken in consideration when the etiology of a E. coli meningitis is not quite clear enough. In this situation, looking for an osteomyelitis whose presence may influence the infant's treatment is needed. 3).
Differential diagnosis
A subgaleal hematoma is an accumulation of blood within the loose connective tissue of the subgaleal space, which is located between the galea aponeurotica and the periosteum
Unlike a cephalohematoma, a subgaleal hematoma can be massive, leading to profound hypovolemic shock.
Case report
Age: 80 years
Gender: Female
Known hypertension (HTA).
History of cholelithiasis.
Valsartan/Hydrochlorothiazide tablets 160 mg/25 mg.
The patient was attended by SAMU due to dizziness and presyncope episode resulting in a fall with traumatic brain injury (TCE) and frontoparietal Cephalohematoma.
The patient received 300 mg of amiodarone. Additionally, the patient took Couldina (containing ephedrine) yesterday
COVID-19 vaccination: 3 doses, last administered in 2021.
No Influenza vaccine this year.
Vital Signs:
Blood Pressure: 180/80 mmHg
Heart Rate: 130 bpm
Oxygen Saturation: 98%
Conscious and oriented in all spheres with preserved language. General good condition, normal color, well-hydrated, well-perfused, and eupneic. Arrhythmic cardiac auscultation without audible murmurs or rubs. Respiratory examination with preserved vesicular murmur. Soft abdomen, non-tender, no signs of peritoneal irritation, no visceromegaly or masses. Negative Blumberg and Murphy signs. No edema or signs of deep vein thrombosis in lower extremities. No neurological focalities or neck stiffness. Left periorbital and temporal hematoma.
Elevated glucose, urea, and chloride levels. Elevated creatinine with reduced glomerular filtration rate. Elevated CRP, pro-BNP, troponin T, and ferritin.
Gasometry
Slightly acidic pH, normal pCO2 and pO2. Elevated lactate. Elevated prothrombin time (Quick index) and D-dimer.
Leukocytosis with increased neutrophils. Anemia with low red blood cell count. Elevated mean corpuscular volume (MCV). Coagulation
Normal APTT ratio, INR, and thrombin time. Elevated D-dimer.
Cerebral CT without contrast shows small frontal left subarachnoid hemorrhage and periventricular/subcortical white matter hypodensities suggestive of microvascular leukoencephalopathy.
Chest X-ray is unremarkable.
COVID Status:
Positive antigen test.
Management:
Metoprolol 5 mg IV initiated on arrival.
Recommended treatment for atrial fibrillation: Eliquis 5 mg every 12 hours indefinitely and Bisoprolol 2.5 mg daily.
Cardiology appointment requested for further evaluation before discharge.
Conclusion: The patient presented with a traumatic brain injury, subarachnoid hemorrhage, and atrial fibrillation. She has been admitted for observation, and the interdisciplinary team will manage her care. Follow-up with cardiology and neurosurgery is planned to address both the cardiac and neurological aspects of her condition.