Massive scalp hematoma: An unusual presentation of valproic acid toxicity

Area of Science:

• Pediatric Neurology
• Pharmacovigilance
• Neuroscience

Background:

• Valproic acid (VPA) is a widely prescribed antiepileptic medication, particularly in pediatric populations.
• While effective for seizure control, VPA is associated with a spectrum of adverse effects.
• Known complications include dose-related hematologic toxicity and rare instances of intracranial bleeding.

Observation:

• A rare case involving a pediatric patient is presented.
• The patient experienced a massive scalp hematoma following a seemingly minor fall.
• This event occurred concurrently with documented high levels of valproic acid in the blood.

Findings:

• The scalp hematoma was of significant size, necessitating surgical intervention.
• The clinical presentation suggests a potential link between elevated VPA levels and increased bleeding risk, even after minor trauma.
• This case underscores the importance of monitoring VPA levels and potential bleeding complications.

Implications:

• This case highlights a rare but severe adverse event associated with valproic acid therapy in children.
• It emphasizes the need for heightened awareness among clinicians regarding the potential for significant bleeding complications, even with minor trauma, in patients with high VPA levels.
• Further investigation into the mechanisms underlying VPA-induced coagulopathy and scalp hematoma formation may be warranted.