Hair-Pulling Scalp Trauma: Lump Evaluation and Urgent Care Guidance

A scalp lump after forceful hair pulling requires prompt medical evaluation. Potential injuries:

Possible Pathologies

• Subgaleal hematoma: Bleeding between galea and periosteum – fluctuant, enlarging, crosses sutures. Can cause significant blood loss (especially children).
• Cephalohematoma: Subperiosteal bleed – confined by suture lines, firmer.
• Skull fracture: Depressed or linear; may underlie hematoma.
• Concussion/TBI: Rotational force from hair pull → coup-contrecoup injury.
• Laceration/avulsion: Scalp tear, possibly with galeal involvement.
• Cervical spine injury: Forced flexion/extension.

Red Flags (Emergency Department Now)

• Loss of consciousness, confusion, vomiting, seizure
• Progressive headache, focal neurologic signs
• Rapidly expanding scalp swelling
• Clear fluid from nose/ears (CSF leak)
• Neck pain, limited range of motion

Evaluation

• CT head (fracture, bleed)
• C-spine imaging if mechanism suggests
• Neurologic exam serial monitoring
• Wound exploration if laceration suspected

Legal/Safety Note

Assault by intimate partner. Document injuries. Consider safety planning, reporting, support services (hotline: [phone]-SAFE).

Do not wait. Scalp vascularity + intracranial risk = urgent evaluation.