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

Abstract

Subgaleal hemorrhage is uncommon in infants beyond the newborn period and, when disproportionate to the reported causal trauma, raises suspicion for child abuse. We describe a 9-month-old girl who developed a large right subgaleal and small epidural hematoma after a 50 cm fall. Initial abuse evaluation was negative, and standard coagulation tests were normal, although von Willebrand factor (vWF) activity was elevated. However, repeat testing 2 months later revealed markedly reduced vWF antigen and activity, suggestive of type 1 von Willebrand disease (vWD). This case highlights that disproportionate bleeding after minor head trauma should prompt evaluation for both non-accidental injury and occult bleeding disorders, and that variability in vWF levels necessitates repeat testing for accurate interpretation.