Cranial hematomas can be either extra-axial (outside the brain), occurring between membranes covering the brain, or intra-axial (inside the brain). The most common extra-axial hematomas are epidural, subdural, and subarachnoid hematomas. Epidural hematomas typically result from injuries that rupture the middle meningeal artery. Subdural hematomas are caused by tears in bridging veins, while subarachnoid hematomas usually stem from ruptured cerebral aneurysms. In newborns, common cranial hematomas include caput succedaneum, cephalohematoma, and subgaleal hematoma, which are usually due to difficult childbirth and

1. Cranial Hematomas

2. Hematoma
• Localized collection of blood outside the blood vessels, &
then coagulate and solidify before blood is reabsorbed.
Disease: sickle cell disease, infection, tumors
Trauma: injury or surgery
• Hemorrhage is active or ongoing bleeding.
• Hematoma is a pathologic collection of blood in body tissues, outside
of blood vessels.

3. Classification
Loaction
• Cranial hematoma
• Subdermal hematoma
• Breast hematoma
• Perichondral hematoma
• Perianal hematoma
• Subungual hematoma
Size
• Petechia < 2 mm
• Purpura 2 mm – 1 cm
• Bruise (ecchymosis, contusion) > 1 cm

4. Cranial hematomas
• Intra-axial (cerebral) hematoma:
• Intraparenchymal
• Intraventricular
• Extra-axial hematoma:
• Epidural
• Subdural
• Subarachnoid

5. Caput succedaneum
• Between the scalp and the periosteum.
• Caused by the pressure of the presenting part
of the scalp against the dilating cervix during
delivery.
• Presents as a scalp swelling that extends
across the midline and over suture lines and is
associated with head molding.
• Usually resolves over the first few days.
• Management consists of observation only.

6. Subgaleal hematoma
• Occurs in the space between the
skull periosteum and the scalp galea
(epicranial) aponeurosis.
• Ruptures the emissary veins.
• Ventouse (vacuum extraction): used in
the second stage of labour if it has not
progressed adequately.
• Raccoon eyes, hemorrhagic shock,
hyperbilirubinemia.

7. Cephalohematoma
• Occurs between the skull and
the periosteum of a newborn secondary to
rupture of blood vessels crossing the
periosteum.
• Due to prolonged second stage of labor or
instrumental delivery.
• Jaundice, anemia, hypotension
• Risk of infection: osteomyelitis, meningitis
• Differential diagnosis: subgaleal hematoma

8. Epidural hematoma
• Mostly originate from meningeal arteries,
particularly in the temporal region.
• Commonly results from a blow to the side of the
head.
• Anterior division of the middle meningeal
artery runs underneath the pterion.
• Lucid interval, unconsciousness, loss of pupillary
light reflex, Cushing’s triad.

9. Subdural hematoma
• Between the dura mater and arachnoid mater.
• Results from tears in bridging veins which cross
the subdural space.
• Slower onset than epidural.
• Life-threatening when acute, but
better prognosis if chronic.
• Increased intracranial pressure leading to
gradual increase of headache & confusion with
slowly progressive neurologic deterioration.

10. Subarachnoid hematoma
• Between the arachnoid membrane and the pia
mater.
• ~85% rupture of a cerebral aneurysm.
• They tend to be located in the Circle of Willis and
its branches.
• Thunderclap headache,
vomiting, seizures, decreased
level of consciousness,
hemiparesis, Terson syndrome.