Head Injury with Growing Bump After 3 Days: When to Seek Medical Care

Delayed Worsening of a Scalp Hematoma

A scalp hematoma ("goose egg") that enlarges after 72 hours is not typical and warrants evaluation. Possible causes:

• Continued slow bleeding (coagulopathy, anticoagulants).
• Infection (cellulitis, abscess).
• Underlying skull fracture with expanding epidural/subdural hematoma.
• Venous thrombosis.

Red Flags Requiring Immediate ER Visit

• Worsening headache, vomiting, confusion, drowsiness.
• Focal neurologic deficits (weakness, vision change, speech difficulty).
• Seizure.
• Clear fluid from nose/ears (CSF leak).
• Bruising behind ears (Battle's sign) or around eyes (raccoon eyes).

Assessment

1. Neurologic exam.
2. CT head (if indicated by Canadian CT Head Rule or clinical judgment).
3. Coagulation studies if on anticoagulants.

Bottom Line

Any worsening head injury sign after 3 days needs professional assessment—do not wait.