From the Research
Subgaleal hemorrhage typically does not cause increased intracranial pressure (ICP). This is because subgaleal hemorrhage occurs in the potential space between the periosteum of the skull and the galea aponeurosis, which is outside the cranial vault. Blood accumulating in this space remains external to the skull and does not directly compress the brain or affect the volume within the rigid cranial compartment. The blood from a subgaleal hemorrhage can spread extensively across the scalp due to the loose connective tissue in this space, but it cannot cross the cranial sutures to enter the intracranial space. However, it's essential to note that subgaleal hemorrhage can sometimes be associated with underlying conditions that may independently cause increased ICP, such as skull fractures or intracranial bleeding, as discussed in the context of managing elevated ICP 1, 2, 3. In neonates with significant subgaleal hemorrhage, severe blood loss can lead to hypovolemic shock and subsequent cerebral hypoperfusion, which might indirectly affect brain function, but this is different from direct ICP elevation, a condition that requires immediate intervention to prevent further brain damage or death 1. Any patient with a subgaleal hemorrhage should be monitored for signs of associated injuries that could affect ICP, emphasizing the importance of careful evaluation and management to prevent morbidity and mortality 2, 3.
Key considerations in managing patients with potential for increased ICP include understanding the causes of elevated ICP, such as intracranial bleeds, and the importance of maintaining cerebral perfusion pressure (CPP) within a specific range to ensure adequate cerebral perfusion 1, 3. The use of interventions like decompressive surgery, osmotherapy, and hyperventilation should be tailored to the individual patient's condition, considering the underlying diagnosis and intracranial pathophysiology 3. Given the potential for hemorrhagic complications with intracranial pressure monitors, as noted in pediatric patients 4, careful consideration of the risks and benefits of such interventions is crucial.
In the context of subgaleal hemorrhage and its potential impact on ICP, monitoring for associated injuries and managing the hemorrhage appropriately are critical to preventing indirect effects on brain function and ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life. This approach aligns with the principles of managing elevated ICP, which prioritize reducing intracranial volume and maintaining optimal CPP to prevent brain damage or death 1, 3.