Isolated traumatic retroclival hematoma: case report and review of literature

Abstract

BackgroundRetroclival hematomas are a rare entity. The pathology can be categorized into epidural hematoma or subdural hematoma based on the anatomy of the tectorial membrane. Frequently, the etiology is related to accidental trauma, though other mechanisms have been observed, including coagulopathy, non-accidental trauma, and pituitary apoplexy. There have been only 2 prior cases where both epidural and subdural hematoma co-present.Case presentationAn 8-year-old male was involved in a high-speed motor vehicle accident. He presented with a Glasgow Coma Score (GCS) of 14 with bilateral abducens nerve palsies. Computed tomography (CT) revealed a hemorrhage along the dorsum sella, clivus, and dens. Magnetic resonance imaging (MRI) demonstrated the retroclival hematoma in both the subdural and epidural space. At discharge, 19 days after the accident, the abducens nerve palsies had resolved without medical or operative intervention.ConclusionRetroclival hematoma may present after trauma. Although most cases exhibit a benign clinical course with conservative management, significant and profound morbidity and mortality have been reported. Prompt diagnosis with close observation is prudent. Surgical management is indicated in the presence of hydrocephalus, symptomatic brainstem compression, and occipito-cervical instability.

Retroclival subdural hematoma associated with warfarin: A case report

“…3 RCSDH, similar to its epidural counterpart, most commonly occurs due to blunt head trauma, followed by pituitary apoplexy or aneursym rupture, and rarely spontaneously. 4 Patients with bleeding disorders -either genetic, acquired or iatrogenic-may have increased risk for hemorrhage into this area. 1,5,6 RCSDH usually present with acute onset severe headache and/or cranial nerve palsies, especially abducens nerve.…”

Retroclival epidural hematoma: A rare location of epidural hematoma, case report, and review of literature

“…Based on clival venous anatomy and bleeding mechanisms, retroclival hematomas can be classified as epidural, subdural, or interdural. [ 13 ] A retrospective study by Krishnan et al . reported that most retroclival hematomas are epidural although some cases are interdural.…”

Post Traumatic Retroclival Epidural Hematoma in a Young Adult.

“…Une revue de la littérature [2,3,4] montre que le traitement conservateur est généralement adopté en première ligne, seuls les cas avec compression critique des éléments de la FCP doivent bénéficier d'une évacuation chirurgicale de l'hématome du fait du risque hémorragique élevé.…”

“…Cependant, ceux de localisation retroclivale sont exceptionnellement rares [1,2,3]. Cette entité a été décrite la première fois en 1941 par Coleman et Thomson [2], et depuis lors, moins de 30 cas d'hématome épidural retroclival post traumatique ont été rapportés dans la littérature [4], intéressant presque exclusivement la population pédiatrique [3,4]. Le cas que nous rapportons est l'un des rares cas rapportés chez l'adulte.…”