Management of Dizziness After Trauma with Subgaleal Hematoma

Immediate Diagnostic Workup

All patients with dizziness following head trauma and subgaleal hematoma require immediate non-contrast CT scan to rule out intracranial hemorrhage, particularly subdural hematoma, which can be life-threatening and requires urgent neurosurgical evaluation 1, 2, 3
Obtain urgent non-contrast head CT to exclude subdural hematoma, which may coexist with subgaleal hematoma and requires neurosurgical consultation regardless of size 1, 3
Obtain urgent non-contrast head CT to exclude subarachnoid hemorrhage, a catastrophic emergency with >40% mortality requiring immediate neurosurgical intervention and vascular imaging 3
Obtain urgent non-contrast head CT to exclude intracranial mass effect or midline shift 2, 3
Complete neurological assessment, including Glasgow Coma Scale score, is necessary for patients with dizziness following head trauma and subgaleal hematoma 2
Pupillary examination and focal neurological deficits should be included in the complete neurological assessment 2
Verify anticoagulant or antiplatelet use, as these medications dramatically increase risk of both subgaleal hematoma expansion and intracranial hemorrhage 2

Immediate neurosurgical consultation is mandatory if CT shows subdural hematoma or other intracranial pathology, and do not independently decide on conservative management 1
Subdural hematoma >10 mm thickness requires urgent surgical evacuation 1
Any subdural hematoma with midline shift >5 mm requires surgical intervention 2
Even small subdural hematomas (<5 mm) require neurosurgical assessment as they can expand rapidly, especially in anticoagulated patients 1, 2
Maintain systolic blood pressure >100 mmHg or mean arterial pressure 80-110 mmHg during evaluation and transfer to prevent secondary brain injury 1, 3, 4, 5
Maintain euvolemia to optimize cerebral perfusion 1, 2
Reverse anticoagulation immediately if applicable 2

Never assume dizziness is benign without neuroimaging, as intracranial hemorrhage can present with minimal symptoms initially but deteriorate rapidly 1, 2, 3
Do not delay CT to obtain laboratory results if patient is stable for transport 3
Avoid hypotension during evaluation, as cerebral perfusion pressure must be maintained to prevent secondary brain injury 3, 4, 5
Do not rely on clinical examination alone to distinguish between isolated subgaleal hematoma and intracranial injury - CT is mandatory 3