Neurological Disorders

Subgaleal Hematoma vs Cephalohematoma: Differences and Similarities

This article provides an explanation of subgaleal hematoma and cephalohematoma, two types of hematoma a medical condition in which the blood accumulates in one place. Both of them are quite common among newborns and we will explore their definitions, causes, and symptoms and will compare the two.
Frederika Malichová

Frederika Malichová

Neuroscientist at the University Of Cambridge.

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Overview

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Differences Between Subgaleal Hematoma And Cephalohematoma

Subgaleal hematoma and cephalohematoma are both conditions that we frequently observe in newborns.

The biggest differences between these two are their location and causes, although both conditions are found near the brain. In addition to that, subgaleal hematoma is typically a more serious condition and may lead to some complications.


Subgaleal Hematoma and Cephalohematoma should not be confused with other forms of hematoma, such as epidural and subdural hematoma.

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Subgaleal hematomas in newborns are most commonly caused by traumatic deliveries, particularly those involving the use of vacuum extraction or forceps. These instruments can cause rupture of the emissary veins, leading to bleeding between the scalp veins and the epicranial aponeurosis. Other risk factors include prolonged labor, difficult deliveries, coagulopathies, and certain maternal and fetal conditions. In rare cases, subgaleal hematomas can occur spontaneously or be associated with congenital bleeding disorders. [1] [2] [3]

Cephalohematoma in infants is typically managed conservatively without treatment, as most cases resolve on their own within a few weeks to a few months. However, in rare cases, treatment may be necessary. Treatment options include aspiration or drainage of the hematoma, especially if it is large or causing significant cosmetic deformity. Surgical intervention may be considered for persistent or ossified cephalohematomas. In cases of infection, antibiotics may be prescribed. It is important to consult with a healthcare professional for proper evaluation and management. [1], [2], [3]

What Is Cephalohematoma?

Cephalohematoma is a medical condition referring to an accumulation of blood between a baby’s scalp and the skull. To be precise, it is located above the skill but beneath the outer covering of the bone called periosteum.

It is a condition typically associated with damaged blood vessels, which happens during labor and delivery. The blood from these damaged vessels then accumulates under the skin of the scalp [1].

Oftentimes, cephalohematoma happens with operative and prolonged deliveries of the babies. In most cases, it resolves spontaneously within a short time of typically one month [2].

Generally, it does not affect the brain as the blood is sitting on top of the skull not under it [1, 3].

What Is Subgaleal Hematoma ?

A subgaleal hematoma is a medical condition characterized by the accumulation of blood within the subgaleal space [4]. The subgaleal space is located between the galea aponeurosis and periosteum of the skull [4].

Subgaleal hematoma occurs when the emissary veins between the periosteal and aponeurotic layers of the scalp rupture [2]. This condition is associated with head trauma and even minor injuries.

It is most commonly reported in pediatric patients, specifically newborns [5, 6]. Usually, it is due to continuous head banging, child maltreatment, or repeated falls which may occur due to seizure attacks [2]. Although it is less common, we can observe subgaleal hematoma in adults as well [4].

Typically the subgaleal hematomas resolve spontaneously by absorption without any prescribed intervention or treatment [2]. However, in some cases, it may lead to life-threatening conditions, in which intervention is necessary. In some cases, the hematoma may enlarge and the patient requires a surgical procedure to have it removed [2].

Interestingly, the largest subgaleal hematoma documented in medical literature had approximately 1300 ml [2].

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Signs of a subgaleal hematoma can include fever, irritability, increased scalp swelling, skin erythema, and site tenderness. In some cases, the hematoma may present as rapid increase in head circumference. Other symptoms can include anemia, leukocytosis, and intermittent fever. If the hematoma becomes infected, it may lead to local signs of infection. In severe cases, it can cause hemorrhagic shock and encephalopathy [1, 2, 3, 4].

A subgaleal hematoma can be diagnosed through various methods. Imaging tests such as CT or MRI scans provide detailed images of the brain, skull, veins, and blood vessels, and can reveal the presence of blood on the surface of the brain. A blood test called a complete blood count (CBC) may also be ordered to check for abnormalities in red blood cell count, white blood cell count, and platelet count. Physical examination, including checking heart rate and blood pressure, can also provide evidence of internal bleeding. [1]

Summary: Subgaleal Hematoma vs Cephalohematoma

Both subgaleal hematoma and cephalohematoma are types of hematomas occurring in the head and typically associated with pediatric patients. However, they do have differences in their location, risk factors, and also potential complications.

A cephalohematoma refers to the accumulation of blood beneath the periosteum in newly born babies. Usually, this condition resolves alone within a month [2] and even though it may sound scary, it does not pose any significant risk to the patient [5]. That being said, there are rare cases that required surgical treatment [2].

On the other hand, a subgaleal hematoma is a blood accumulation under the scalp. It may lead to significant blood loss and these types of hematomas are often associated with head trauma. Such hematoma has been linked to severe headaches or potential scalp necrosis [6, 4].

One key difference between the two is that a cephalohematoma does not cross the sagittal suture, while a subgaleal hematoma can extend across the suture line [7]. This distinction can be crucial in diagnosing and treating these conditions.

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Frederika Malichová

Frederika Malichová

Frederika is a postgraduate researcher at the University of Cambridge, where she investigates new biomarkers for Frontotemporal Dementia and other tauopathies. Her research has been published at prestigious conferences such as the Alzheimer’s Association International Conference 2023. She obtained her BSc in Biomedical Sciences from UCL, where she worked closely with the UK Dementia Research Institute.