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A marked exophthalmos and corneal ulceration caused by delayed massive expansion of a subgaleal hematoma

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Abstract

Case report

A 12-year-old girl had the hair on the right side of her head pulled during a quarrel, after which a subgaleal hematoma (SGH) developed over her right cranium. The subcutaneous swelling progressed to the forehead, and a marked exophthalmos then developed on the left side. The bilateral, liquefied SGH was removed surgically, and two drainage catheters connected to a vacuum-drain pump were introduced. After the surgery, the SGH disappeared. The liquefied hematoma was aspirated by puncturing the superolateral portion of the left orbit. Thereafter, the left exophthalmos rapidly disappeared. A chemical analysis of the SGH revealed that it contained extremely low levels of fibrinogen and platelets, and high levels of fibrinogen and fibrin degradation products, suggesting that secondary fibrinolysis had occurred in the subgaleal space.

Discussion and conclusion

Subgaleal hematomas are usually treated conservatively. However, closed observation is necessary, and if increased expansion is seen, aspiration with a closed drainage system should be considered.

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Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neuroscience, Yamaguchi University School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan

    Hirosuke Fujisawa, Koji Kajiwara, Masami Fujii, Shoichi Kato, Tatsuo Akimura & Michiyasu Suzuki

  2. Department of Surgery, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan

    Hiroyasu Yonaha & Yoichiro Oka

  3. Department of Anesthesiology, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan

    Masato Uehara

  4. Department of Radiology, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan

    Yoshihiko Nagata

Authors
  1. Hirosuke Fujisawa
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  2. Hiroyasu Yonaha
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  3. Yoichiro Oka
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  4. Masato Uehara
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  5. Yoshihiko Nagata
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  6. Koji Kajiwara
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  7. Masami Fujii
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  8. Shoichi Kato
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  9. Tatsuo Akimura
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  10. Michiyasu Suzuki
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Corresponding author

Correspondence to Hirosuke Fujisawa.

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Fujisawa, H., Yonaha, H., Oka, Y. et al. A marked exophthalmos and corneal ulceration caused by delayed massive expansion of a subgaleal hematoma. Childs Nerv Syst 21, 489–492 (2005). https://doi.org/10.1007/s00381-004-1054-8

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  • DOI: https://doi.org/10.1007/s00381-004-1054-8

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