Disproportionate Subgaleal Hemorrhage in an Infant: Abuse or Bleeding Disorder?

Area of Science:

• Pediatric Medicine
• Neurology
• Hematology

Background:

• Subgaleal hemorrhage is rare in infants post-newborn period.
• Disproportionate bleeding after minor trauma raises concern for non-accidental injury.
• Occult bleeding disorders can mimic or exacerbate head trauma findings.

Purpose of the Study:

• To report a case of subgaleal hemorrhage in an infant with fluctuating von Willebrand factor levels.
• To emphasize the importance of considering both child abuse and bleeding disorders in such cases.
• To highlight the necessity of repeat testing for von Willebrand factor (vWF) in diagnosis.

Main Methods:

• Case report of a 9-month-old girl with subgaleal and epidural hematoma after a fall.
• Initial evaluation for child abuse and standard coagulation tests.
• Serial testing of von Willebrand factor (vWF) antigen and activity levels.

Main Results:

• Initial abuse evaluation and coagulation tests were normal.
• Elevated vWF activity was noted initially.
• Repeat testing revealed markedly reduced vWF antigen and activity, consistent with type 1 von Willebrand disease (vWD).

Conclusions:

• Disproportionate head trauma bleeding in infants warrants evaluation for non-accidental injury and occult bleeding disorders.
• Variability in vWF levels necessitates repeat testing for accurate diagnosis of von Willebrand disease.
• This case underscores the differential diagnosis in pediatric head trauma with unusual bleeding patterns.