A neonate or young infant who has had a head injury may be noticed to have a swelling of the scalp afterwards. A careful physical examination is often able to identify the cause of the swelling.
Examinations:
(1) pattern of scalp swelling
(2) transillumination of the skull
Scalp Swelling
Transillumination
Probable Diagnosis
focal
decreased
cephalohematoma
focal
increased
porencephalic or leptomeningeal cyst
diffuse
decreased
subgaleal hematoma
diffuse
increased
caput succedaneum
where:
• Caput succedaneum is edema within and under the scalp.
• A subgaleal hematoma is one in the subgaleal space, between the galea aponeurosis and the pericranium.
• A cephalohematoma is one between the pericranium and the bone of the skull.
• Porenchephalic or leptomeningeal cysts are located in the subgaleal space and communicate to intracranial structures through a defect in the skull, usually at the site of a previous linear or diastatic skull fracture.
Attempting to aspirate these lesions is not recommended since this can be complicated by infections which are difficult to treat.
Usually no therapy is required for caput succedaneum or for the hematomas.
The porencephalic or leptomeningeal cyst need to be removed surgically with repair of the skull and dural defects.
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