Cephalohematoma

Cephalohematoma is a collection of blood or hematoma between the scalp and the skull periosteum, located in the subperiosteal space and as such, is contained anatomically to a single skull bone, typically caused by ruptured blood vessels during childbirth, and it usually resolves on its own within a few weeks to months ¹, ², ³, ⁴. Cephalhematoma usually involves the parietal or occipital bone, sharply limited by the margins of the bone and does not cross the suture lines ⁵. During the birthing process, shearing forces on the skull and scalp result in the separation of the periosteum from the underlying skull bone, resulting in the subsequent rupture of emissary or diploic veins ⁶. A cephalohematoma is usually a harmless birth injury that often appears as a soft, raised lump on a newborn’s head several hours after birth. Over time, the body resorbs the blood. Depending on the size, most cephalohematomas take two weeks to three months to disappear completely. If the area of bleeding is large, some babies may develop jaundice as the red blood cells break down or anemia (a condition of not having enough healthy red blood cells or hemoglobin to carry oxygen to the body’s tissues). It is important to differentiate cephalohematoma from caput succedaneum, which is scalp swelling that crosses suture lines, whereas a cephalohematoma is a localized blood clot that stays within suture lines and is contained anatomically to a single skull bone ¹, ⁷. Caput succedaneum is a common benign boggy diffuse swelling with poorly defined margins that is observed on an infant’s scalp shortly after vaginal birth, which can make baby’s head appearing cone-shaped ⁷. Caput succedaneum is a benign condition associated with birth-related trauma to the scalp during delivery ⁷.

The scalp refers to the layers of skin and subcutaneous tissue (also known as the hypodermis, the deepest layer of the skin that lies beneath the dermis) that cover the bones of your skull. The scalp consists of 5 layers. The mnemonic ‘SCALP’ can be a useful way to remember the layers of the scalp: Skin, Connective Tissue, Epicranial Aponeurosis, Loose Areolar Connective Tissue and Periosteum (see Figure 2 below). The first three layers are tightly bound together and move as a collective structure.

1. Skin – the skin contains numerous hair follicles and sebaceous glands (a small gland in the skin found in your hair follicles that secrete sebum or an oily substance that protects your skin from drying out).
2. Dense Connective tissue – the connective tissue connects your skin to the epicranial aponeurosis. The connective tissue has a very dense network of blood vessels and nerves. Furthermore, the blood vessels within the connective tissue layer are highly adherent to the connective tissue. This renders them unable to constrict fully if lacerated so the scalp can be a site of profuse bleeding.
3. Epicranial Aponeurosis also known as the galea aponeurotica – The epicranial aponeurosis is a strong, thin, fibrous sheet that forms the middle, or third, layer of the scalp. The epicranial aponeurosis is a large, flat tendon that connects the front and back bellies of the occipitalis and frontalis muscles, allowing the scalp and eyebrows to move. This structure is important for facial expressions and provides a strong, yet movable, layer for the scalp.
4. Loose Areolar Connective Tissue – The loose areolar connective tissue is a thin connective tissue layer that separates the periosteum of the skull from the epicranial aponeurosis. The loose areolar connective tissue contains numerous blood vessels, including emissary veins which connect the veins of the scalp to the diploic veins and intracranial venous sinuses.
5. Periosteum – The periosteum is the sheath outside of the skull bones that supplies them with blood, nerves and the cells that help them grow and heal. The periosteum becomes continuous with the endosteum at the suture lines. The endosteum is a thin vascular membrane of connective tissue that lines the center of your skull bones that contain bone marrow. The endosteum is also known as lining membrane of the bone marrow cavity.

Cephalohematoma can happen naturally during childbirth. Cephalohematoma causes and risk factors may include:

• Difficult delivery: Pressure on the baby’s head during a prolonged or difficult vaginal birth can cause blood vessels to rupture.
• Instrument-assisted delivery: The use of forceps or vacuum extractors can increase the risk.
• Infant size: Larger infants or a large baby’s head relative to the mother’s pelvis are risk factors.
• Breech presentation has been identified as a risk factor.

Cephalohematoma most commonly occurs during the birthing process and rarely in adolescence and adults following trauma or surgery. External pressure on the fetal head results in the rupture of small blood vessels between the periosteum and skull bone. External pressure on the fetal head is increased when the head is compressed against the maternal pelvis during labor or when additional external forces are applied from instruments such as forceps or a vacuum that may be used to assist with the birth. Shearing action between the periosteum and the underlying calvarium causes slow bleeding. As blood accumulates, the periosteum elevates away from the skull. As the bleeding continues and fills the subperiosteal space, pressure builds, and the accumulated blood acts as a tamponade to stop further bleeding.

Cephalohematoma occurs with an incidence of 0.4% to 2.5% of all live births ⁸. For unknown reasons, cephalohematomas occur more often in male than female infants ⁹, ¹⁰. The lowest incidence of cephalohematoma occurs in unassisted vaginal delivery (1.67%) ¹¹. Cephalohematomas are more common in women who is pregnant for the first time (primigravidae), large infants (macrosomia), infants in an occipital posterior or transverse occipital position at the start of labor, and following instrument-assisted deliveries with forceps or a vacuum extractor ⁸. Amongst instrument-assisted deliveries, cephalohematomas occur most commonly following vacuum-assisted delivery (11.17% of deliveries), compared to forceps-assisted and cesarean delivery (6.35%) ¹¹, ¹². A cesarean section that is initiated before the commencement of natural labor, however, is not associated with cephalohematoma ⁸.

Sometimes a cephalohematoma may results from medical professionals’ mistakes, including the following:

• Excessive or improper use use of birth-assisting tools
• Applying undue pressure during delivery
• Ordering improper procedures

However, most cephalohematoma cases are harmless and do not affect long-term health or brain development, as the blood clot is outside the skull.

Cephalohematoma in newborn signs and symptoms may include:

• A raised, often firm or soft lump that may be red or bruised on the baby’s head.
• A cephalohematoma may not be visible immediately but can appear a few hours or days after birth.
• The swelling is often contained by the skull’s sutures.

Cephalohematoma can be diagnosed by a pediatrician based on its appearance and location, and imaging is rarely needed.

A comprehensive history of labor and birth is necessary to identify newborns at risk of developing cephalohematoma. Factors that increase pressure on the fetal head and the risk of developing a cephalhematoma should be identified, including a prolonged second stage of labor, abnormal fetal presentation, macrosomia, and operative or surgical delivery ¹. Due to the slow nature of subperiosteal bleeding, cephalohematomas usually are absent at birth but become most noticeable within the first 1 to 3 days following birth ¹. Therefore, repeated inspection and palpation of the newborn’s head is necessary to identify the presence of a cephalohematoma ¹. Ongoing assessment to document the appearance of a cephalohematoma is important. Once a cephalohematoma is present, assessing and documenting changes in size is continued. A newborn may initially present with a firm but increasingly fluctuant area of swelling over which the scalp moves easily ¹³. A firm, enlarged unilateral or bilateral bulge on top of 1 or more bones below the scalp characterizes a cephalohematoma ¹. Cranial sutures define the boundaries of the cephalohematoma ¹. The parietal or occipital region of the calvarium is the most common site of injury, but a cephalohematoma can occur over any cranial bone. The raised area cannot be transilluminated, and the overlying skin is usually not discolored or injured ¹.

Cephalohematoma newborn treatment and management are primarily observational ¹. The mass from a cephalohematoma can take weeks to resolve as the clotted blood is slowly absorbed ¹. Over time, the bulge may feel harder as the collected blood calcifies. The blood then starts to be reabsorbed. Sometimes, the center of the bulge begins to disappear before the edges do, giving a crater-like appearance ¹. This is the expected course for the cephalohematoma during resolution ¹⁴, ¹⁵, ¹⁶, ¹⁷. Cephalohematoma should not be aspirated or drained unless there is a concern for infection ¹, ¹⁸. Aspiration is often not effective because the blood has clotted ¹. Also, entering the cephalohematoma with a needle increases the risk of infection and abscess formation ¹. The best treatment is to observe the area alone and give the body time to reabsorb the collected fluid ¹.

There is an ongoing debate regarding conservative management versus early surgical intervention for cephalohematoma, as there are currently no randomized controlled trials for reference. It has been suggested that early surgical intervention is not necessary if the cephalohematoma diameter is >50 mm unless other clinical indications are present ¹⁰. In patients with later-stage ossification or calcification, the advocates for surgery argue that outcomes are superior with intervention at an earlier age due to the infant’s natural molding process, decreased risk of elevated intracranial pressure, and cosmetic advantage ¹³. A rare surgical indication for ossified cephalohematoma is persistent cosmetic disfigurement ¹³. When indicated, ossified cephalohematoma can be treated safely and surgically with craniotomy or craniectomy and cranioplasty, yielding good outcomes ¹⁹, ⁸, ²⁰. The surgical technique involves resection of the overlying newly formed bone, the soft tissue mass, and the underlying original bone ¹⁹. Following removal, the underlying depressed region is often sectioned into multiple pieces and is remodeled as a bone graft. There are multiple techniques for cranioplasty, each with favorable outcomes and minimal if any, residual evidence in the following years ⁸.

Children typically do not have an associated neurologic deficit as the cephalohematoma is superficial to the skull bone and not in contact with the brain tissue ¹⁹. In rare instances, cephalohematomas may calcify (a process in which the blood clot becomes hardened) or lead to cosmetic deformities, but these occurrences are uncommon and typically do not result in long-term adverse effects on the infant’s health ¹. Rare complications associated with cephalohematoma include anemia, infection with abscess formation, jaundice, low blood pressure (hypotension), intracranial hemorrhage (bleeding inside the skull), and underlying linear skull fractures (5% to 20% of cases) ¹³, ²¹, ²².

Figure 1. Normal skull of newborn

Figure 2. Scalp anatomy

Figure 3. Scalp nerves and arteries

Footnotes: Illustration includes supratrochlear nerve, supraorbital nerve, zygomaticotemporal nerve, auriculotemporal nerve, lesser occipital nerve, greater occipital nerve, supratrochlear artery, supratorbital artery, zygomaticotemporal artery, superficial temporal artery, posterior auricular artery, and occipital artery.

[Source ²³ ]

Figure 4. Hemorrhages by location within the different layers of the scalp (right of image) and meninges (left of image)

Footnote: Caput succedaneum is collection within the subcutaneous fibrofatty tissues superficial to galea aponeurosis. Cephalohematoma is bleeding into the fetal scalp that is located in the subperiosteal space.

Figure 5. Cephalohematoma newborn

Figure 6. Cephalohematoma progressive enlargement

Footnotes: A male baby was admitted to a hospital on day 8 of life with progressive jaundice which had been first noted on day 2 of life and had worsened over time. At presentation on day 8, transcutaneous bilirubin was 17 mg/dl, and serum total bilirubin was 316.2 μmol/L with direct bilirubin of 11.5 μmol/L. The infant was alert, feeding well, and exhibited no signs of acute bilirubin encephalopathy (e.g., poor feeding, lethargy, or high-pitched cry). The patient was the first child of nonconsanguineous parents born at 39+4 weeks of gestation via cesarean section. His birth weight was 3,800 g and his Apgar scores were 10 at 1, 5, and 10 min. No perinatal complications occurred. Owing to significant hyperbilirubinemia, the patient was admitted for further evaluation. Physical examination revealed that the infant was alert and had generalized jaundice. A sizable cephalohematoma (approximately 6 × 10 cm), which was tense and fluctuating, was noted over the parietal scalp. Bruising was observed at the venipuncture sites on the neck and right upper arm. Joint swelling was not observed. Neurological, cardiac, respiratory, and abdominal examination results were unremarkable. The neonatal behavioral neurological assessment and bilirubin-induced neurologic dysfunction scores were 39 and 0, respectively. After admission, the progressive enlargement of the cephalohematoma raised concerns about an underlying coagulation dysfunction, prompting further coagulation function tests. Laboratory workup upon admission revealed anemia (hemoglobin level, 86 g/L). Coagulation tests revealed a significantly prolonged APTT (180.6 s). The patient’s factor VIII activity was <1%, with normal levels of other clotting factors, confirming the diagnosis of severe hemophilia A caused by a deficiency of clotting factor VIII.

[Source ²⁴ ]

Figure 7. Caput succedaneum

Figure 8. Cephalohematoma in newborn head

Footnote: One month old male baby with history of traumatic delivery presenting with right parietooccipital soft tissue swelling. (a) Transverse grayscale ultrasound image of the left parietooccipital scalp shows a complex fluid collection (arrow), with punctate linear echogenic foci along the superficial aspect (arrowheads), suggestive of calcifications. Relationship with the adjacent left lambdoid suture was difficult to evaluate by ultrasound. (b) Coronal non-contrast head CT image demonstrates a lobulated fluid collection with thick septations and peripheral calcifications (arrowheads) that does not cross the adjacent sagittal or the lambdoid suture, suggestive of cephalhematoma. (c) 3-D volume rendered images in bone algorithm shows cortical irregularity along the left parietal bone at the site of cephalhematoma as well as peripheral calcifications along the superficial aspect of the cephalhematoma. (d) Coronal T2 image from an MR exam obtained one week later in the setting of patient’s seizures re-demonstrates the large subperiosteal complex fluid collection with thick septations and isointense fluid signal consistent with evolving blood products in the known left parietal cephalhematoma

[Source ²⁵ ]

Figure 9. Cephalohematoma with abscess

Footnotes: A 4-week-old male term infant presented with 1 day of irritability and fever. The perinatal course had been uncomplicated following a spontaneous vaginal delivery. There had been no instrumental assistance or intrapartum fetal scalp electrode monitoring during parturition. Maternal intrapartum penicillin was given for group B streptococcal prophylaxis and the newborn
was noted to have a large cephalohematoma at birth. A septic screen performed prior to administration of antibiotics revealed a urinary tract infection (UTI) with pure growth culture of Escherichia coli (>100 x 10⁹ CFU/mL), susceptible to gentamicin and ceftriaxone. The initial cerebrospinal fluid (CSF) revealed a normal cell count on microscopy (nucleated cell count 2 x
10⁶/L), normal biochemistry and negative culture. The blood culture was also negative, white cell count (WCC) was 5.7 x 10⁹/L and C-reactive protein (CRP) was 77.4 mg/L. Cranial ultrasound showed a lentiform 8.9 x
6.9 cm collection consistent with a large uncomplicated cephalohematoma. Following 4 days of therapy with sensitive antibiotics, he continued to have persistent fever and irritability, coverage was broadened to meropenem and he was transferred to a tertiary paediatric center for further investigations. (a) Coronal view of magnetic resonance imaging (MRI) of the brain with contrast demonstrates the large cephalohematoma over the left parietal convexity. On day 12 of admission, the cephalohematoma became warm and fluctuant with associated elevated white cell count (WCC) of 23.6
x 10⁹/L and C-reactive protein (CRP) of 118 mg/L. Purulent fluid was percutaneously aspirated with subsequent incision and drainage under general anesthesia. The aspirate and operative swabs cultured Escherichia coli, with an identical susceptibility profile to the initial urine specimen. Another incision and drainage was performed 3 days later due to reaccumulation. Following this, the child defervesced and improved markedly. (b) Coronal view of the a computerized tomography (CT) scan without contrast of the head after two surgical debridement procedures. A persistent fluid collection at the left parietal scalp/bone shown is in keeping with a residual cephalohematoma. Superficial to this is a hyperattenuating rind containing multiple coarse foci of calcification demonstrating visible periosteal reaction. Within the soft tissue edema, there are numerous loculations of fluid with pockets of gas.

[Source ³ ]

Figure 10. Cephalohematoma in adult

Footnotes: Axial non-contrast head CT demonstrating a small left parietal scalp hematoma (left image, arrow) associated with a subtle underlying non-displaced left parietal bone fracture (center image, arrow) in a young child. 3D volume rendered reconstructions, which increase sensitivity for identifying non-displaced fractures, better depict the linear left parietal bone fracture (right image, arrow) that extends through the left squamosal suture (right image, arrowhead). No intracranial hemorrhage was present.

[Source ²⁶ ]

Cephalohematoma vs Caput succedaneum

Caput succedaneum is a common benign boggy diffuse swelling with poorly defined margins that is observed on an infant’s scalp shortly after vaginal birth, which can make baby’s head appearing cone-shaped. Caput succedaneum is associated with serosanguinous and/or hemorrhagic fluid collection above the epicranial aponeurosis (a strong, large flat tendon sheet that forms the middle, or third, layer of the scalp) and beneath the overlying skin of the scalp ⁷. Caput succedaneum is observed on a newborn’s scalp shortly after delivery, is poorly defined and crosses suture lines and resolves on its own within a few days without long-term effects, although it can increase the risk of jaundice ⁷. Caput succedaneum is a birth-related trauma to the baby’s scalp due to molding of the baby’s head during vaginal birth. During childbirth (vaginal birth), the baby’s head is subjected to pressure in the mother’s birth canal by both the uterine and vaginal walls as it passes through the cervix. Caput succedaneum is more often associated with a prolonged labor in vertex delivery. Vertex delivery refers to a vaginal birth where the baby is positioned head-first, with the back of the baby’s head called the “vertex” entering the birth canal first, and the baby’s chin tucked to its chest ²⁷. Vertex delivery is the most common and safest presentation for birth, as it presents the smallest part of the baby’s head to the mother’s pelvis ²⁷.

In addition, caput succedaneum has also been associated with both forceps and vacuum-assisted delivery when the vacuum cup contacts the head ²⁸. Operative vaginal delivery or a vaginal birth that uses instruments, such as forceps or a vacuum extractor, to assist with delivery when a baby needs to be born more quickly ²⁹, ³⁰, ³¹. Operative vaginal delivery is used for maternal or fetal reasons, such as prolonged active labor, maternal exhaustion, or concerns about the baby’s health during birth. The choice between forceps and vacuum depends on the clinical situation, physician preference, and the mother’s acceptance. Operative vaginal delivery represents roughly five percent of all deliveries in the United States ².

Caput succedaneum is characterized by a fluid-filled, soft, and sometimes bruised area that crosses suture lines and is most often caused by prolonged or difficult labor, assisted deliveries like vacuum or forceps, or prolonged pressure of the head against the cervix. Risk factors for caput succedaneum included a protracted active labor course, vaginal birth that uses instruments, low amniotic fluid (oligohydramnios), a woman who is pregnant for the first time (primigravida pregnancy), Braxton-Hicks contractions (irregular contractions also known as false labor pains) and premature rupture of membranes (the breaking of the amniotic sac before labor begins or before regular contractions that result in cervical dilation or onset of labor). Vacuum-assisted vaginal delivery is the most significant risk factor for developing caput succedaneum and scalp injury, even in comparison to forceps-assisted vaginal delivery. Indications for vacuum-assisted vaginal delivery include but are not limited to a prolonged second stage of labor, nonreassuring fetal heart patterns, and maternal exhaustion ².

Protracted active labor course diagnosis is made when there are less than 1.2 centimeters of cervical dilation per hour in nulliparous women and less than 1.5 centimeters of cervical dilation per hour for multiparous women (females who has given birth more than once). The prolonged second stage of labor differs for nulliparous women (females who have never given birth to a live baby) and multiparous women (females who has given birth more than once). A diagnosis of “prolonged second stage of labor” is made in a multiparous mother when there is no dilation after three hours using anesthetics or no dilation after two hours without the use of anesthetics. This diagnosis is made in a nulliparous mother when there is no dilation after two hours with the use of anesthetics or no dilation after one hour without the use of anesthetics.

A caput succedaneum is more likely to form during a long or hard vaginal delivery. Caput succedaneum is more common after the membranes have broken. This is because the fluid in the amniotic sac is no longer providing a cushion for the baby’s head. Vacuum extraction done during a difficult birth can also increase the chances of a caput succedaneum.

A caput succedaneum may be detected by prenatal ultrasound, even before labor or delivery begins. It has been found as early as 31 weeks of pregnancy. Very often, this is due to an early rupture of the membranes or too little amniotic fluid. It is less likely that a caput succedaneum will form if the membranes stay intact.

Cephalohematoma is bleeding into the fetal scalp that is located in the subperiosteal space and as such, is contained anatomically to a single skull bone ². Cephalhematoma is a collection of blood (hematoma) between the skull and its periosteum. Cephalhematoma usually involves the parietal or occipital bone, sharply limited by the margins of the bone and does not cross the suture lines ³². Cephalohematoma often appears several hours after birth as a raised lump on the baby’s head. Over time, the body resorbs the blood. Depending on the size, most cephalohematomas take two weeks to three months to disappear completely. If the area of bleeding is large, some babies may develop jaundice as the red blood cells break down.

In contrast to caput succedaneum where the scalp swelling is present at birth and typically disappears in the following days, cephalohematoma often appears as a soft, raised lump on a newborn’s head several hours after birth and resolves on its own within a few weeks to months. Cephalohematoma swelling typically resolves itself between two weeks to six months ⁷. Approximately 15% of cephalohematoma are bilateral.

A cephalohematoma is a fluctuant swelling limited by suture lines. Cephalohematoma is caused by rupture of superficial veins between the skull and periosteum, may be associated with linear skull fractures and can cause significant jaundice. Cephalohematoma occurs in 1 to 3% of live births; but can be up to 4% following instrumental deliveries.

Cephalohematoma newborn

Cephalohematoma is a collection of blood or hematoma between the scalp and the skull periosteum, located in the subperiosteal space and as such, is contained anatomically to a single skull bone, typically caused by ruptured blood vessels during childbirth, and it usually resolves on its own within a few weeks to months ¹, ², ³, ⁴. Cephalhematoma usually involves the parietal or occipital bone, sharply limited by the margins of the bone and does not cross the suture lines ⁵. During the birthing process, shearing forces on the skull and scalp result in the separation of the periosteum from the underlying skull bone, resulting in the subsequent rupture of blood vessels. A cephalohematoma is usually a harmless birth injury that often appears as a soft, raised lump on a newborn’s head several hours after birth. Over time, the body resorbs the blood. Depending on the size, most cephalohematomas take two weeks to three months to disappear completely. If the area of bleeding is large, some babies may develop jaundice as the red blood cells break down or anemia (a condition of not having enough healthy red blood cells or hemoglobin to carry oxygen to the body’s tissues). It is important to differentiate cephalohematoma from caput succedaneum, which is scalp swelling that crosses suture lines, whereas a cephalohematoma is a localized blood clot that stays within suture lines and is contained anatomically to a single skull bone ¹, ⁷. Caput succedaneum is a common benign boggy diffuse swelling with poorly defined margins that is observed on an infant’s scalp shortly after vaginal birth, which can make baby’s head appearing cone-shaped ⁷. Caput succedaneum is a benign condition associated with birth-related trauma to the scalp during delivery ⁷.

The diagnosis of cephalohematoma in newborn is largely a clinical one. Cephalohematoma diagnosis is based on the characteristic bulge on the newborn’s head that does not cross cranial suture lines. The bulge may be initially firm and become more fluctuant as time passes. In contrast to caput succedaneum and subgaleal hematoma, cephalohematoma becomes most apparent in the first 1 to 3 days following birth rather than being immediately apparent after birth ⁷, ³³. Some doctors may request additional tests, including skull X-rays, computed tomography (CT) scans of the head, or head ultrasound for further evaluation ³⁴. Skull X-rays and CT imaging may be useful if there is suspicion of an underlying skull fracture. CT imaging and head ultrasound can be useful in evaluating intracranial hemorrhage (bleeding inside the skull) and further defining the extracranial compartment in which the hemorrhage is located. Infants should be evaluated for bleeding disorder, such as von Willebrand disease, which may have predisposed the baby to develop cephalohematoma ¹³. Needle aspiration of the cephalohematoma is discouraged due to the risk of introducing infection and is only indicated if an infection is suspected. Escherichia coli is the primary pathogen associated with an infected cephalohematoma ³⁵, ¹³, ¹⁹.

Cephalohematoma newborn treatment and management are primarily observational ¹. The mass from a cephalohematoma can take weeks to resolve as the clotted blood is slowly absorbed ¹. Over time, the bulge may feel harder as the collected blood calcifies. The blood then starts to be reabsorbed. Sometimes, the center of the bulge begins to disappear before the edges do, giving a crater-like appearance ¹. This is the expected course for the cephalohematoma during resolution ¹⁴, ¹⁵, ¹⁶, ¹⁷. Cephalohematoma should not be aspirated or drained unless there is a concern for infection ¹. Aspiration is often not effective because the blood has clotted ¹. Also, entering the cephalohematoma with a needle increases the risk of infection and abscess formation ¹. The best treatment is to observe the area alone and give the body time to reabsorb the collected fluid ¹.

There is an ongoing debate regarding conservative management versus early surgical intervention for cephalohematoma, as there are currently no randomized controlled trials for reference. It has been suggested that early surgical intervention is not necessary if the cephalohematoma diameter is >50 mm unless other clinical indications are present ¹⁰. In patients with later-stage ossification or calcification, the advocates for surgery argue that outcomes are superior with intervention at an earlier age due to the infant’s natural molding process, decreased risk of elevated intracranial pressure, and cosmetic advantage ¹³. A rare surgical indication for ossified cephalohematoma is persistent cosmetic disfigurement ¹³. When indicated, ossified cephalohematoma can be treated safely and surgically with craniotomy or craniectomy and cranioplasty, yielding good outcomes ¹⁹, ⁸. The surgical technique involves resection of the overlying newly formed bone, the soft tissue mass, and the underlying original bone ¹⁹. Following removal, the underlying depressed region is often sectioned into multiple pieces and is remodeled as a bone graft. There are multiple techniques for cranioplasty, each with favorable outcomes and minimal if any, residual evidence in the following years ⁸.

Cephalohematoma time to resolve

Most cases (approximately 80%) of cephalohematoma resorb within the first month of life ¹⁹.

Cephalohematoma newborn causes

Cephalohematoma most commonly occurs during the birthing process and rarely in adolescence and adults following trauma or surgery. External pressure on the fetal head results in the rupture of small blood vessels (emissary or diploic veins) between the periosteum and skull bone ⁶. External pressure on the fetal head is increased when the head is compressed against the maternal pelvis during labor or when additional external forces are applied from instruments such as forceps or a vacuum that may be used to assist with the birth. Shearing action between the periosteum and the underlying calvarium causes slow bleeding. As blood accumulates, the periosteum elevates away from the skull. As the bleeding continues and fills the subperiosteal space, pressure builds, and the accumulated blood acts as a tamponade to stop further bleeding.

Cephalohematoma occurs with an incidence of 0.4% to 2.5% of all live births ⁸. For unknown reasons, cephalohematomas occur more often in male than female infants ⁹, ¹⁰. The lowest incidence of cephalohematoma occurs in unassisted vaginal delivery (1.67%) ¹¹. Cephalohematomas are more common in women who is pregnant for the first time (primigravidae), large infants (macrosomia), infants in an occipital posterior or transverse occipital position at the start of labor, and following instrument-assisted deliveries with forceps or a vacuum extractor ⁸. Amongst instrument-assisted deliveries, cephalohematomas occur most commonly following vacuum-assisted delivery (11.17% of deliveries), compared to forceps-assisted and cesarean delivery (6.35%) ¹¹, ¹². A cesarean section that is initiated before the commencement of natural labor, however, is not associated with cephalohematoma ⁸.

Risk factors for developing cephalohematoma

These factors increase the risk of a newborn having cephalohematoma:

• Difficult childbirth requiring assisted delivery using vacuum extraction or forceps.
• Epidural pain relief during childbirth.
• Larger-than-average baby (fetal macrosomia) weighing more than 8 pounds 13 ounces.
• Multiple babies (twins, triplets or more).
• Prolonged, difficult vaginal delivery.
• Breech fetus (feet or buttocks first delivery)
• Preterm birth.

Cephalohematoma newborn signs and symptoms

Cephalohematoma in newborn signs and symptoms may include:

• A raised, often firm or soft lump that may be red or bruised on the baby’s head.
• A cephalohematoma may not be visible immediately but can appear a few hours or days after birth.
• The swelling is often contained by the skull’s sutures.

Some children show signs of newborn cephalohematoma immediately after birth. Other symptoms may take a few days or weeks to show.

There is a difference between bruises and newborn cephalohematoma. A hematoma or collection of blood can physically look like a bruise because it causes a dark spot on the baby’s head. Bruises may develop on the baby’s scalp hours after minor injuries during delivery, whereas hematomas are caused by significant head trauma.

Cephalohematoma newborn complications

Rare complications associated with cephalohematoma include anemia, infection with abscess formation, jaundice, low blood pressure (hypotension), intracranial hemorrhage (bleeding inside the skull), and underlying linear skull fractures (5% to 20% of cases) ¹³, ²¹, ²². Cephalohematomas may calcify or lead to cosmetic deformities, though such occurrences are infrequent.

Cephalohematoma newborn diagnosis

The diagnosis of cephalohematoma in newborn is largely a clinical one. Cephalohematoma diagnosis is based on the characteristic bulge on the newborn’s head that does not cross cranial suture lines. The bulge may be initially firm and become more fluctuant as time passes. In contrast to caput succedaneum and subgaleal hematoma, cephalohematoma becomes most apparent in the first 1 to 3 days following birth rather than being immediately apparent after birth ⁷, ³³. Some doctors may request additional tests, including skull X-rays, computed tomography (CT) scans of the head, or head ultrasound for further evaluation ³⁴.

The steps in diagnosing cephalohematoma in infant include:

• Physical examination: Your baby’s doctor will examine your child’s head to see if it is growing or expanding more than normal.
• Blood tests: Doctors will run a hematocrit test to check your child’s red blood cell count compared to the rest of the blood in their body. This can be an indication of hematoma.
• Imaging scans: X-rays, CT (computed tomography) scans, and MRI (magnetic resonance imaging) scans can help doctors find the size and location of the hematoma.

Skull X-rays and CT imaging may be useful if there is suspicion of an underlying skull fracture. CT imaging and head ultrasound can be useful in evaluating intracranial hemorrhage (bleeding inside the skull) and further defining the extracranial compartment in which the hemorrhage is located. Infants should be evaluated for bleeding disorder, such as von Willebrand disease, which may have predisposed the baby to develop cephalohematoma ¹³. Needle aspiration of the cephalohematoma is discouraged due to the risk of introducing infection and is only indicated if an infection is suspected. Rarely, severe complications can develop with subcutaneous infections with abscess formation, with or without visible skin trauma. Escherichia coli is the primary pathogen associated with an infected cephalohematoma ³⁵, ¹³, ¹⁹.

Cephalohematoma newborn differential diagnosis

A thorough history and physical should be completed on every neonate that presents with scalp swelling to differentiate cephalohematoma from caput succedaneum, a benign self-resolving condition and from more life-threatening causes of scalp swelling that require closer monitoring and further management. Other common causes of neonatal scalp swelling that present similarly include but are not limited to:

1. Caput succedaneum is a common benign boggy diffuse swelling with poorly defined margins that is observed on an infant’s scalp shortly after vaginal birth, which can make baby’s head appearing cone-shaped. Caput succedaneum is associated with serosanguinous and/or hemorrhagic fluid collection above the epicranial aponeurosis (a strong, large flat tendon sheet that forms the middle, or third, layer of the scalp) and beneath the overlying skin of the scalp ⁷. Caput succedaneum is observed on a newborn’s scalp shortly after delivery, is poorly defined and crosses suture lines and resolves on its own within a few days without long-term effects, although it can increase the risk of jaundice ⁷. Caput succedaneum is a birth-related trauma to the baby’s scalp due to molding of the baby’s head during vaginal birth. During childbirth (vaginal birth), the baby’s head is subjected to pressure in the mother’s birth canal by both the uterine and vaginal walls as it passes through the cervix. Caput succedaneum is more often associated with a prolonged labor in vertex delivery. Vertex delivery refers to a vaginal birth where the baby is positioned head-first, with the back of the baby’s head called the “vertex” entering the birth canal first, and the baby’s chin tucked to its chest ²⁷. Vertex delivery is the most common and safest presentation for birth, as it presents the smallest part of the baby’s head to the mother’s pelvis ²⁷.
2. Subgaleal hemorrhage is a rare but serious condition in newborns where blood collects in the space between the skull’s periosteum and the scalp’s galea aponeurosis that is associated with birth trauma located inferior to the epicranial aponeurosis that can present as swelling on the scalp that crosses suture lines and then spreads diffusely. Subgaleal hemorrhage is often caused by vacuum-assisted birth. Subgaleal hemorrhage can lead to significant blood loss, causing symptoms like swelling, bruising, lethargy, poor feeding, hypotonia, rapid heart rate, seizures, skull fractures and potentially hypovolemic shock, anemia, and death if not managed urgently. Early detection and management are critical, and newborns are monitored closely for signs of this condition. Subgaleal hemorrhage is associated with a high mortality rate and subgaleal hemorrhage can result in hypovolemia, coagulopathy, and hyperbilirubinemia. Subgaleal hemorrhage is also associated with vacuum and forceps-assisted delivery. The subgaleal space is large, and the fluid collection has the potential to extend behind the orbits and back on the neck as well. In comparison to the edema found in caput succedaneum, both will cross midline as the fluid collection is above the cranial suture lines in both cases. However, subgaleal hemorrhage will be much more diffuse ³⁶, ³⁷.
3. Subdural hemorrhage refers to hemorrhage associated with birth trauma that occurs between the dura and arachnoid space ³⁸, ³⁹.

Cephalohematoma newborn treatment

Cephalohematoma newborn treatment and management are primarily observational ¹. The mass from a cephalohematoma can take weeks to resolve as the clotted blood is slowly absorbed ¹. Over time, the bulge may feel harder as the collected blood calcifies. The blood then starts to be reabsorbed. Sometimes, the center of the bulge begins to disappear before the edges do, giving a crater-like appearance ¹. This is the expected course for the cephalohematoma during resolution ¹⁴, ¹⁵, ¹⁶, ¹⁷. Cephalohematoma should not be aspirated or drained unless there is a concern for infection ¹, ¹⁸. Aspiration is often not effective because the blood has clotted ¹. Also, entering the cephalohematoma with a needle increases the risk of infection and abscess formation ¹. Escherichia coli is the primary pathogen associated with an infected cephalohematoma ³⁵, ¹³, ¹⁹. The best treatment is to observe the area alone and give the body time to reabsorb the collected fluid ¹.

There is an ongoing debate regarding conservative management versus early surgical intervention for cephalohematoma, as there are currently no randomized controlled trials for reference. It has been suggested that early surgical intervention is not necessary if the cephalohematoma diameter is >50 mm unless other clinical indications are present ¹⁰. In patients with later-stage ossification or calcification, the advocates for surgery argue that outcomes are superior with intervention at an earlier age due to the infant’s natural molding process, decreased risk of elevated intracranial pressure, and cosmetic advantage ¹³. A rare surgical indication for ossified cephalohematoma is persistent cosmetic disfigurement ¹³. When indicated, ossified cephalohematoma can be treated safely and surgically with craniotomy or craniectomy and cranioplasty, yielding good outcomes ¹⁹, ⁸, ²⁰. The surgical technique involves resection of the overlying newly formed bone, the soft tissue mass, and the underlying original bone ¹⁹. Following removal, the underlying depressed region is often sectioned into multiple pieces and is remodeled as a bone graft. There are multiple techniques for cranioplasty, each with favorable outcomes and minimal if any, residual evidence in the following years ⁸.

Cephalohematoma newborn prognosis

A cephalohematoma is usually a harmless birth injury that often appears as a soft, raised lump on a newborn’s head several hours after birth. Approximately 80% of cephalohematoma cases the blood get resorbed by the body within the first month of life ¹⁹. Usually, cephalohematomas do not present any problems to a newborn. The exception is an increased risk of neonatal jaundice in the first days after birth. Therefore, the newborn needs to be carefully assessed for a yellowish discoloration of the skin, sclera, or mucous membranes. Noninvasive measurements with a transcutaneous bilirubin meter can be used to screen the infant. A serum bilirubin level should be obtained if the newborn exhibits signs of jaundice. Rarely, calcification or ossification may occur in cases that are not resolved ¹⁹, ⁴⁰. A skull x-ray or CT scan of the head is indicated in patients whose cephalohematomas have not resorbed within 6 weeks of birth ¹³. Rather than absorbed, an ossified cephalohematoma has hardened and has a clearly defined outer and inner layer of the bone surrounding the lesion ¹⁹, ⁸. The inner layer of the ossified cephalohematoma is composed of the outer and inner table of the infant’s skull bone. In contrast, the outer table comprises the infant’s sub-pericranial bone derived from the elevated pericranium ¹⁹. The contour of the ossified cephalohematoma’s inner layer can either follow the skull’s convex shape or become concave, encroaching upon the intracranial compartment ¹⁹.

Children typically do not have an associated neurologic deficit as the cephalohematoma is superficial to the skull bone and not in contact with the brain tissue ¹⁹. In rare instances, cephalohematomas may calcify (a process in which the blood clot becomes hardened) or lead to cosmetic deformities, but these occurrences are uncommon and typically do not result in long-term adverse effects on the infant’s health ¹. Rare complications associated with cephalohematoma include anemia, infection with abscess formation, jaundice, low blood pressure (hypotension), intracranial hemorrhage (bleeding inside the skull), and underlying linear skull fractures (5% to 20% of cases) ¹³, ²¹, ²².

Cephalohematoma in adults

Cephalohematoma in adults is typically caused by a head injury such as a blow or knock to the head, that appears as a raised bump, bruise or swelling or it can be more serious, leading to brain injuries such as concussion or bleeding on the brain. Cephalohematoma in adults are common, often harmless, and may be called a “goose egg”, but can also be a sign of a more serious injury like a skull fracture if symptoms are severe. Most minor scalp hematomas resolve on their own in a few days or weeks, but larger ones may take longer to heal.

Head injuries can be serious even if you can’t see them. They can lead to permanent disability, or even death. It can be hard to know how serious the injury is when it first happens. You may feel well and act normally, but become unwell later. A general rule is the more forceful the impact, the more likely there is a severe injury. If you have a head injury you should see a doctor.

Cephalohematoma in adults signs and symptoms may include:

• Swelling, redness, and pain
• A visible bump on the head, or a “goose egg”
• Tenderness to the touch

Seek immediate medical attention if the scalp hematoma is accompanied by symptoms like severe headache, confusion, or other signs of a more serious head injury, as this could indicate an underlying skull fracture or intracranial hemorrhage.

Symptoms of a minor head injury without concussion include:

• a bump or bruise
• no vomiting
• being alert
• interacting with others

These head injuries can usually be monitored at home and if any new symptoms develop then you should see a doctor.

Concussion is a head injury that affects how the brain works, usually temporarily. You may have passed out or be confused.

Concussion can include symptoms such as:

• headache
• nausea and dizziness
• vision changes
• poor balance
• difficulty remembering things or thinking slowly
• changes in sleep
• changes in emotion including anxiety, irritability and sadness

Go to the emergency room straight away or call your local emergency services number and ask for an ambulance if you have a head injury and:

• the head injury involved high speeds or a fall from more than one meter
• vomit more than once or are unable to control your bowel or bladder
• have trouble seeing, hearing or speaking normally
• you lose consciousness or seems drowsy, agitated or restless
• have a severe or worsening headache or neck pain which is getting worse or won’t go away
• are confused, disorientated, have memory loss, have trouble remembering things or are not able to stay awake during the day
• have bleeding or fluid coming from the ear or nose
• have a seizure, blackout or feel like you will faint
• have weakness or numbness or tingling anywhere in your body

Signs of a serious head injury can start later, even after you go home from hospital.

You should also see your doctor if:

• you develop any other new symptoms
• you are concerned

Cephalohematoma in adults treatment depends on the severity of your head injury and the presence of other injuries, your treatment may include:

• Minor hematomas: These often resolve on their own with rest and ice. A doctor may advise close monitoring for potential complications like anemia, jaundice, infections, skull fractures and calcifications.
• Large or deep hematomas: May require immediate medical attention. In some cases, the blood may need to be surgically drained. You may require emergency surgery to minimize additional damage to your brain tissues. Surgery may be used to address the following problems:
  • Removing clotted blood (hematomas). Bleeding outside or within the brain can result in a collection of clotted blood (hematoma) that puts pressure on the brain and damages brain tissue.
  • Repairing skull fractures. Surgery may be needed to repair severe skull fractures or to remove pieces of skull in the brain.
  • Bleeding in the brain. Head injuries that cause bleeding in the brain may need surgery to stop the bleeding.
  • Opening a window in the skull. Surgery may be used to relieve pressure inside the skull by draining accumulated cerebrospinal fluid or creating a window in the skull that provides more room for swollen tissues.

For small scalp hematomas, rest, ice, compression, and elevation (RICE) can reduce swelling. Severe or large scalp hematomas may require medical attention, including observation, drainage of the blood via a simple procedure or surgical evacuation (craniotomy) to relieve pressure on the brain.

If you have a severe head injury, you may require monitoring for increased intracranial pressure (pressure inside your skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to brain damage.

Scalp hematomas can also occur as a side effect of medical procedures such as platelet-rich plasma (PRP) therapy and hair transplantation. In such cases, aspiration and compression bandages are effective in managing the hematoma ⁴¹.

Cephalohematoma in adults causes

• Blunt trauma: A bump or blow to the head can cause a scalp hematoma due to the scalp’s rich blood supply.
  • Causes of head injuries include:
    • Vehicle-related collisions. Collisions involving cars, motorcycles or bicycles and pedestrians involved in such accidents are a common cause of traumatic brain injury.
    • Sports injuries. Traumatic brain injuries may be caused by injuries from a number of sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports. These are particularly common in youth.
    • Accidents at home
    • Accidents at work
    • Violence. Gunshot wounds, domestic violence, child abuse and other assaults are common causes. Shaken baby syndrome is a traumatic brain injury in infants caused by violent shaking.
    • Falls. Falls from bed or a ladder, down stairs, in the bath, and other falls are the most common cause of traumatic brain injury overall, particularly in older adults and young children.
    • Explosive blasts and other combat injuries. Explosive blasts are a common cause of traumatic brain injury in active-duty military personnel. Although how the damage occurs isn’t yet well understood, many researchers believe that the pressure wave passing through the brain significantly disrupts brain function.
• Surgical procedures: These can also cause a scalp hematoma.

Cephalohematoma in adults signs and symptoms

Cephalohematoma in adults signs and symptoms may include:

• Swelling, redness, and pain
• A visible bump on the head, or a “goose egg”
• Tenderness to the touch

Seek immediate medical attention if the scalp hematoma is accompanied by symptoms like severe headache, confusion, or other signs of a more serious head injury, as this could indicate an underlying skull fracture or intracranial hemorrhage.

Symptoms of a minor head injury without concussion include:

• a bump or bruise
• no vomiting
• being alert
• interacting with others

These head injuries can usually be monitored at home and if any new symptoms develop then you should see a doctor.

Concussion is a head injury that affects how the brain works, usually temporarily. You may have passed out or be confused.

Concussion can include symptoms such as:

• headache
• nausea and dizziness
• vision changes
• poor balance
• difficulty remembering things or thinking slowly
• changes in sleep
• changes in emotion including anxiety, irritability and sadness

Go to the emergency room straight away or call your local emergency services number and ask for an ambulance if you have a head injury and:

• the head injury involved high speeds or a fall from more than one meter
• vomit more than once or are unable to control your bowel or bladder
• have trouble seeing, hearing or speaking normally
• you lose consciousness or seems drowsy, agitated or restless
• have a severe or worsening headache or neck pain which is getting worse or won’t go away
• are confused, disorientated, have memory loss, have trouble remembering things or are not able to stay awake during the day
• have bleeding or fluid coming from the ear or nose
• have a seizure, blackout or feel like you will faint
• have weakness or numbness or tingling anywhere in your body

Signs of a serious head injury can start later, even after you go home from hospital.

You should also see your doctor if:

• you develop any other new symptoms
• you are concerned

Cephalohematoma in adults diagnosis

A scalp hematoma is diagnosed through a physical exam and imaging tests. During a physical exam, your doctor will look for swelling and bruising, feel the scalp area for abnormalities like an underlying skull fracture, and ask about your injury. If necessary, imaging tests like a CT scan or ultrasound can provide a more detailed view and help rule out an underlying skull fracture or other intracranial injuries. Tissue swelling from a traumatic brain injury can increase pressure inside the skull and cause additional damage to the brain. Doctors may insert a probe through the skull to monitor this pressure.

Imaging tests

• Computed Tomography (CT) scan: A CT scan uses a series of X-rays to create a detailed view of the brain. Computerized tomography (CT) scan is usually the first performed in an emergency room for a suspected traumatic brain injury. A CT scan can quickly visualize fractures and uncover evidence of bleeding in the brain (hemorrhage), blood clots (hematomas), bruised brain tissue (contusions), and brain tissue swelling. This is a key diagnostic tool to get a detailed view of your skull and can show if the hematoma is causing pressure on the brain tissue or if there is an underlying skull fracture.
• Magnetic resonance imaging (MRI): An MRI uses powerful radio waves and magnets to create a detailed view of the brain. MRI can also be used for further evaluation, though CT scans are often the first-line imaging for acute head injuries. MRI may be used after the person’s condition stabilizes, or if symptoms don’t improve soon after the injury.
• Ultrasound: This can be useful for smaller or shallower hematomas, and in newborns, it can help evaluate the hematoma and any potential intracranial bleeding.
• Skull X-rays: These may be used if there is a high suspicion of an underlying skull fracture.

Cephalohematoma in adults treatment

Treatment for a scalp hematoma in adults will be determined by your doctor based on:

• Your age, overall health, and medical history
• Extent of your head injury
• Type of head injury
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the head injury
• Your opinion or preference

Depending on the severity of your head injury and the presence of other injuries, your treatment may include:

• Ice and Rest
• Topical antibiotic ointment and adhesive bandage
• Observation
• Immediate medical attention
• Stitches
• Hospitalization for observation
• Moderate sedation or assistance with breathing that would require being placed on a breathing machine, or mechanical ventilator or respirator
• Surgery. You may require emergency surgery to minimize additional damage to your brain tissues. Surgery may be used to address the following problems:
  • Removing clotted blood (hematomas). Bleeding outside or within the brain can result in a collection of clotted blood (hematoma) that puts pressure on the brain and damages brain tissue.
  • Repairing skull fractures. Surgery may be needed to repair severe skull fractures or to remove pieces of skull in the brain.
  • Bleeding in the brain. Head injuries that cause bleeding in the brain may need surgery to stop the bleeding.
  • Opening a window in the skull. Surgery may be used to relieve pressure inside the skull by draining accumulated cerebrospinal fluid or creating a window in the skull that provides more room for swollen tissues.

For small scalp hematomas, rest, ice, compression, and elevation (RICE) can reduce swelling. Severe or large scalp hematomas may require medical attention, including observation, drainage of the blood via a simple procedure or surgical evacuation (craniotomy) to relieve pressure on the brain.

If you have a severe head injury, you may require monitoring for increased intracranial pressure (pressure inside your skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to brain damage.

Scalp hematomas can also occur as a side effect of medical procedures such as platelet-rich plasma (PRP) therapy and hair transplantation. In such cases, aspiration and compression bandages are effective in managing the hematoma ⁴¹.

Mild injury

Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relievers to treat a headache. However, a person with a mild traumatic brain injury usually needs to be monitored closely at home for any persistent, worsening or new symptoms. He or she may also have follow-up doctor appointments.

Your doctor will indicate when a return to work, school or recreational activities is appropriate. Relative rest, which means limiting physical or thinking (cognitive) activities that make things worse, is usually recommended for the first few days or until your doctor advises that it’s OK to resume regular activities. It isn’t recommended that you rest completely from mental and physical activity. Most people return to normal routines gradually.

Immediate emergency care

Emergency care for moderate to severe traumatic brain injuries focuses on making sure the person has enough oxygen and an adequate blood supply, maintaining blood pressure, and preventing any further injury to the head or neck.

People with severe injuries may also have other injuries that need to be addressed. Additional treatments in the emergency room or intensive care unit of a hospital will focus on minimizing secondary damage due to inflammation, bleeding or reduced oxygen supply to the brain.

Medications

Medications to limit secondary damage to the brain immediately after an injury may include:

• Anti-seizure drugs. People who’ve had a moderate to severe traumatic brain injury are at risk of having seizures during the first week after their injury. An anti-seizure drug may be given during the first week to avoid any additional brain damage that might be caused by a seizure. Continued anti-seizure treatments are used only if seizures occur.
• Coma-inducing drugs. Doctors sometimes use drugs to put people into temporary comas because a comatose brain needs less oxygen to function. This is especially helpful if blood vessels, compressed by increased pressure in the brain, are unable to supply brain cells with normal amounts of nutrients and oxygen.
• Diuretics. These drugs reduce the amount of fluid in tissues and increase urine output. Diuretics, given intravenously to people with traumatic brain injury, help reduce pressure inside the brain.

Rehabilitation

Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The goal is to improve their abilities to perform daily activities. Therapy usually begins in the hospital and continues at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration of rehabilitation is different for everyone, depending on the severity of the brain injury and what part of the brain was injured.

Rehabilitation specialists may include:

• Physiatrist, a doctor trained in physical medicine and rehabilitation, who oversees the entire rehabilitation process, manages medical rehabilitation problems and prescribes medication as needed
• Occupational therapist, who helps the person learn, relearn or improve skills to perform everyday activities
• Physical therapist, who helps with mobility and relearning movement patterns, balance and walking
• Speech and language therapist, who helps the person improve communication skills and use assistive communication devices if necessary
• Neuropsychologist, who assesses cognitive impairment and performance, helps the person manage behaviors or learn coping strategies, and provides psychotherapy as needed for emotional and psychological well-being
• Social worker or case manager, who facilitates access to service agencies, assists with care decisions and planning, and facilitates communication among various professionals, care providers and family members
• Rehabilitation nurse, who provides ongoing rehabilitation care and services and who helps with discharge planning from the hospital or rehabilitation facility
• Traumatic brain injury nurse specialist, who helps coordinate care and educates the family about the injury and recovery process
• Recreational therapist, who assists with time management and leisure activities
• Vocational counselor, who assesses the ability to return to work and appropriate vocational opportunities and who provides resources for addressing common challenges in the workplace

Cephalohematoma in adults prognosis

The prognosis for an adult scalp hematoma varies based on the type and severity. Minor cephalohematomas that are not inside the skull typically resolve on their own over a few weeks with no treatment. However, more serious internal hematomas like subdural or epidural hematomas can be life-threatening and their prognosis depends heavily on the size of the hematoma, the severity of any associated brain injury, and how quickly the person receives medical attention and treatment, such as surgery.

Minor, non-intracranial hematomas

• Prognosis: Generally excellent; self-resolves over a few weeks.
• Treatment: Observation is the primary treatment. The body reabsorbs the blood over time.
• Appearance: The area may feel harder and the bulge can develop a crater-like appearance as it resolves.

Major, intracranial hematomas (subdural or epidural)

• Prognosis: Can range from poor to excellent depending on the severity of the injury and the patient’s age.
• Risk factors for a poor prognosis include:
  • High Glasgow Coma Scale (GCS) score (indicating severe head injury).
  • Age over 40.
  • Presence of additional brain damage (e.g., contusions).
  • Large size or thickness of the hematoma.
  • Significant midline shift on a scan.
• Treatment: Urgent medical attention is required, often including surgery to relieve pressure on the brain.
• Importance of timing: The prognosis worsens the longer the interval is between the initial decline in consciousness and surgical intervention.
• Potential long-term complications: Even with treatment, complications such as memory loss, seizures, and weakness can occur.

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