1 / 23

Grand Rounds Hair Pulling & Vision Loss

Grand Rounds Hair Pulling & Vision Loss. Sidharth Puri MD, PGY4 August 10, 2018. Patient Presentation. CC Headache, decreased vision and left eye pain HPI 13 yo African American male presenting with headache 5 days after hair was pulled at school

walt
Télécharger la présentation

Grand Rounds Hair Pulling & Vision Loss

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Grand RoundsHair Pulling & Vision Loss Sidharth Puri MD, PGY4 August 10, 2018

  2. Patient Presentation CC Headache, decreased vision and left eye pain HPI • 13 yo African American male presenting with headache 5 days after hair was pulled at school • Initial CT showed subgaleal hematoma, no orbital or ocular involvement. • Returned to ER 2 days later with worsening headache, new onset left eye pain, and decreasing vision

  3. History (Hx) Past Ocular Hx-None Past Medical Hx- Remote hx of rectal bleeding age 6 (negative coagulopathy workup) Past Surgical Hx- None FamHx–Non-contributory Meds –None Allergies –None Social Hx–Student, healthy, lives with family. No concern for child abuse

  4. Review of Systems • Positive for nausea/vomiting

  5. External Exam

  6. Anterior Segment Exam

  7. Posterior Segment Exam

  8. CT Head Original vs 2 Days Later

  9. CT Head Original vs 2 Days Later

  10. CT Orbit Coronal Sagittal

  11. Assessment/Plan • 13 yo male s/p hair-pulling trauma with large subgaleal hematoma, now with extension into left superior orbit, resulting in complete ophthalmoplegia and orbital compartment syndrome. • Emergent canthotomy/cantholysis was performed at bedside • Patient was taken to OR with Oculoplastics for emergent left anterior orbitotomy with hematoma evacuation

  12. Subgaleal Hematomas • Bleeding in potential space between the thin fibrous galeaaponeurotica of the scalp and the periosteum covering the cranium • Occurs in two settings • Neonates with vacuum-assisted vaginal delivery • Childhood traumas (minor and major head trauma)

  13. Subgaleal Hematomas • Orbital extension is very rare • In children, galealaponeurosis is loosely attached to the pericranium • Larger quantity of small emissary veins present compared to adults • Radial or tangential forces may cause rupture of these small vessels • Volume of emissary veins and thinner scalp in children makes them more susceptible to collect blood in subgaleal space

  14. Subgaleal Hematomas • Hemorrhage in subgaleal space can accumulate and dissect to the orbital rim and extend subperiosteally • In children, there may be weaker attachments of periosto-galeal tissue to the bony orbit, allowing extension of blood • Prior reports of minor trauma associated • Hair pulling, hair braiding

  15. Coagulopathy Risk? • Various coagulopathies have been associated with developing of subgaleal hematomas • Factor VII, IX, and XIII • Need to coordinate with hematology team to test for these

  16. KEY POINTS • Subgaleal hematomas are more common in pediatric populations • Worsening subgaleal hematoma with proptosis should raise high suspicion of orbital extension and stat ophthalmological evaluation • Acute intervention with canthotomy/cantholysis, with possible surgical evacuation of hematoma, may be necessary to preserve vision • Thorough hematologic work-up is necessary

  17. References • Puri S, Duff SM, Mueller B, PrendesM, Clark J.Hairpullingcausing vision loss: a case report. Hamlin H. Subgaleal hematoma caused by hair-pull. JAMA 1968;204:339. Orbit. 2018 May 4:1-4. • Edmondson SJ, Ramman S, Haram NH, Bisarya K, Fu B, Ong J, Akhavani M. Hair Today; Scalped tomorrow: Massive Subgaleal Haematoma Following Sudden Hair Pulling in an Adolescent in the Absence of Haematological Abnormality or Skull Fracture. J Craniofac Surg. 2026;27:1261-2 • Karcioglu ZA, Hoehn ME, Lin YP, Walsh J. Ocular involvement after subgaleal hematoma. J AAPOS. 2008 Oct;12(5):521-3. • Jenkins TL, Zheng CX, Murchison AP, Bilyk JR. Orbital Compartment Syndrome Following Post-Traumatic Subgaleal Hematoma. OphthalPlastReconstr Surg 33 (2), e33-e36. Mar-Apr 2017 • Chandrasekar, A., Daniela, L., Devia, Y., Julius, Ramachandra, S., Rajendran, A., Sa, G., S.Shubab, Scott, X., & Vaishnavi (2015). Subgaleal Bleed and Bilateral Proptosis as an Initial Manifestation of Mild Hemophilia a in a Child. Sri Ramachandra Journal of Medicine, Jan- June 2015, Vol.8, Issue 1 • Pope-Pegram LD, Hamill MB. . Post-traumatic subgaleal hematoma with subperiosteal orbital extension. Surv Ophthalmol. 1986 Jan-Feb;30(4):258-62. • Prakash S. Bilateral proptosis from a subgaleal hematoma. J Neurosurg 1990;72:835. • Adeloye A, Adeku EL. Subgaleal haematoma in head injuries. Int Surg 1975;60:263 • Vu TT, Guerrera MF, Hamburger EK, et al. Subgaleal hematoma from hair braiding: Case report and literature review. PediatrEmerg Care 2004;20:821-3 • GuirgisMF, Segal WA, Lueder GT. Subperiosteal orbital hemorrhage as initial manifestation of Christmas disease (factor IX deficiency). Am J Ophthalmol 2002;133:584–5.

  18. Thank You • Dr. Clark

  19. Home of the Innocents Screening 2018

More Related