Céfalo-hematoma subperiosteal gigante ossificado na infância / Ossified giant subperiosteal cephalhematoma in childhood

Hematoma subperiosteal ou céfalo-hematoma, apesar de condição conhecida em neonatos, é rara em adultos e mesmo em crianças maiores, o que levanta a suspeita de uma diferente patogênese entre as duas situações. A cronificação e a ossificação do céfalo-hematoma são condições extremamente infrequentes, com escasso material bibliográfico, e sua presença no adulto é fato inusitado na literatura. Reportamos o caso de um hematoma subperiosteal crônico de grandes proporções, ossificado, com um ano de evolução, tratado cirurgicamente, em um menino de 12 anos de idade com síndrome epiléptica e déficit cognitivo prévios. A revisão e a discussão de sua patogênese e seu tratamento foram realizadas para exposição da condição.

Subperiosteal hematoma or cephalhematoma is a well known condition on newborns, but rare in adults and older children, what may lead to a different pathogenic origin. Chronic or ossificated cephalhematoma are infrequent, with few reports in medical literature. There are no cases reported in adults. It is presented a case of a 12 year-old boy, with previous epileptic syndrome and cognitive deficit, who was admitted because of a large chronic ossified subperiosteal hematoma. It was removed surgically. Revision and discussion of its pathogenesis were prepared for the case presentation.

Correlation between Cephalhematomas and Intracranial Hematomas

PURPOSE: Cephalhematomas rarely lead to serious complications, such as skull fractures and intracranial hematomas, so CT and/or MRI scans are indicated only in cases in which depressed fractures are suspected or neurologic symptoms develop. Nevertheless, we have experienced several cases of cephalhematomas associated with intracranial hematomas in the absence of remarkable neurologic symptoms. The aim of this study was to evaluate the correlation between cephalhematomas and intracranial hematomas and determine the need for neuroimaging in infants with cephalhematomas. METHODS: Infants who were admitted to the NICU with cephalhematomas and underwent neuroimaging (CT and/or MRI) between January 2002 and July 2006 were evaluated. Neuroimaging was done when the symptoms suggested the development of an intracranial hematoma. RESULTS: Among 54 infants with cephalhematomas, 18 infants underwent neuroimaging. Six of 18 infants (33.3%) had intracranial hematomas, 4 infants had epidural hematomas, and 2 infants had subdural hematomas. Four of these 6 infants had neurologic symptoms or depressed skull fractures; 2 infants had no neurologic symptoms or depressed skull fractures. The neuroimaging was done to evaluate the cause of an excessive elevation of serum bilirubin and unexplained anemia. There were no remarkable differences between the infants with and without intracranial hematomas with respect to gestational age, birth weight, head circumference, diameter of the cephalhematoma, neurologic symptoms, and other clinical signs and symptoms. CONCLUSION: Based on this study, intracranial hematomas are common complications of cephalhematomas, thus more careful inspection and neuroimaging may be needed in cases of cephalhematomas in newborns.

Epidural hematoma treated by aspiration of accompanying cephalhematoma in a newborn infant / 소아과

Epidural hematoma is relatively rare in newborn infants and frequently associated with instrumental deliveries or other complications during labor and delivery. Although surgical evacuation has been the most common therapy, many other procedures have been described. Although many epidural hematomas require surgical evacuation rather than nonsurgical management, conservative or aspiration of hematoma have been attempted. In the case of EDH associated with cephalhematoma, aspiration of cephalhematoma could be attempted because frequent features of these combination were communication between these hematoma. We report a case of successful nonsurgical management of epidural hematoma through the aspiration of accompanying cephalhematoma in a 5-day-old newborn infant.

Factores de riesgo asociados a traumatismo al nacimiento / Risk factors for birth injuries

Objective. To identify risk factors associated with birth trauma. Setting. Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", Secretaría de Salud. Design. Case-control, prolective study. Patients. There were 129 cases and 134 controls. Measures. We recorded the following variables: a) maternal and delivery: age, weight, height, prenatal care, pre-existing disease or gestational disease, mode of delivery, anesthetic management during labor, use of external maneuvers or forceps; b) newborn: birth weight, gestational age, academic degree of attendant physician at delivery, and type of birth injury. Results. The independent risk factors associated to birth injury were: for ecchymoses; general anesthesia (OR 13.7, 95% CI - 3 - 62.6), breech presentation (OR 6.4, 95% IC 95% = 1.4 - 27.9) and gestational age < 32 weeks (OR 6.4, 95% CI = 1.3 - 31.1); for lacerations, vaginal dystocic delivery or cesarean section (OR 19, 95% CI = 4.4 - 81.1) and use of external maneuvers (OR 5.6, 95% CI = 1.5 - 21.6); for cephalhematoma maternal height < 1.54 m (OR 7.4, 95% CI = 2.3 - 23.7) and external maneuvers (OR 7.2, 95% CI = 2.3 - 23.7); for caput succedaneum, external maneuvers (OR 3.4, 95% CI = 1.5-7.7) and maternal age < 19 or > 36 years (OR 3.0, 95% CI = 1.4 - 6.4). Conclusions. Risk factors associated with birth injuries identified in this study involved maternal conditions, neonatal conditions and mechanism of delivery.

Objetivo. Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. Lugar. Servicio de Neonatología, Hospital General "Dr. Manuel Gea González", SS. Diseño. Casos y controles, prolectivo. Pacientes. 129 casos y 134 controles. Mediciones. Las variables estudiadas fueron, a) maternas y del parto: edad, peso, talla, control prenatal, enfermedad previa o durante el embarazo, características del trabajo de parto, tipo de anestesia, aplicación de maniobras externas, uso de fórceps; b) en el recién nacido: peso al nacer, edad gestacional, grado académico del médico que atendió el nacimiento y tipo de lesión. Resultados. Los factores que se asociaron en forma independiente a la presentación de traumatismo al nacimiento fueron para equimosis: anestesia general (RM 13.7, IC 95% = 3 - 62.6), presentación pélvica (RM 6.4, IC 95% = 1.4 - 27.9 y edad gestacional < 32 semanas (RM 6.4, IC 95% =1.3 - 31.1); para laceración, nacimiento vaginal distócico o cesárea (RM 19, IC 95% = 4.4 - 81.1), y maniobras externas (RM 5.6, IC 95% = 1.5 - 21.6); para cefalohematoma talla materna < 1.54 m (RM 7.4, IC 95% = 2.3 - 23.7) y maniobras externas (RM 7.2, IC 95% = 2.2 - 23.7); para caput succedaneum maniobras externas (RM 3.4, IC 95% = 1.5 - 7.7) y edad materna < 19 o > 36 años (RM 3.0, IC 95% = 1.4 - 6.4). Conclusiones. Los factores de riesgo asociados a lesiones durante el nacimiento identificados en este estudio involucran tanto características maternas como del recién nacido y de la atención del parto.

Spontaneous Rapid Resolution of Acute Epidural Hematoma in a Neonate

A case of acute epidural hematoma associated with depressed skull fracture and cephalhematoma resolved spontaneously within three days, is reported. A female neonate was admitted for the evaluation of convulsion developed on the next day after delivery. Computed tomography(CT) revealed epidural hematoma and overlying cephalhematoma on the left parietal region. Repeated CT scan after three days showed total resolution of epidural hemotoma and slight enlargement of cephalhematoma. Redistribution of hematoma through communication between epidural hemotoma and cephalhematoma is suggested as the mechanism of spontaneous rapid resolution of epidural hemotoma.

Indications for the Diagnostic Tap of Cephalhematoma: A Survey of Case Reports / 대한주산의학회잡지

PURPOSES: We experienced a case of infected cephalhematoma drained spontaneously. So we wanted to review the most appropriate method for investigating cephalhematomas for possible infection and to clarify the indications for the diagnostic aspiration. METHODS: MEDLINE searches were conducted for the period from 1972 to 1997, and all reports were obtained. 15 articles reporting 18 infected cephalhematomas were identified in the literature. We analyzed the medical records in patients according to age: sex ; associated infections especially sepsis or osteomyelitis, risk factors such as scalp electrode or vacuum use, local signs such as increase in size, fluctuation, local redness: organisrns: and radiographic findings. RESULTS: Escherichia coli was isolated from over 50% of the cephalhematomas that were aspirated. Most patients presented with sepsis, meningitis, and/or osteomyelitis. Plain radiographs, bone scans, and enhanced CT scans were limited in their ability to determine if a cephalhematoma was infected unless associated osteomyelitis existed. Local signs of scalp infection, such as increase in size, fluctuation, local redness were obvious in almost all cases. CONCLUSIONS: Aspiration is the diagnostic procedure of choice for cephalhematomas suspected of being infected. The indications for aspiration were increase in size, development of erythema, development of fluctuation, relapse of systemic infection, or a delay in the resolution of clinical symptoms of infection.

Proptosis from a cephalhematoma in a twelve-year-old girl: a case report

We report a unique case of a 12-year-old girl with unilateral proptosis form orbital extension of an extensive bilateral cephalhematoma. Loss of vision in the left eye due to severe proptosis was reversed by prompt aspiration and tarsorrhaphy.