Retroclival collections associated with abusive head trauma in children

Abstract

Retroclival collections are rare lesions reported almost exclusively in children and strongly associated with trauma. We examine the incidence and imaging characteristics of retroclival collections in young children with abusive head trauma. We conducted a database search to identify children with abusive head trauma ≤ 3 years of age with brain imaging performed between 2007 and 2013. Clinical data and brain images of 65 children were analyzed. Retroclival collections were identified in 21 of 65 (32%) children. Ten (48%) were subdural, 3 (14%) epidural, 2 (10%) both, and 6 (28%) indeterminate. Only 8 of 21 retroclival collections were identifiable on CT and most were low or intermediate in attenuation. Eighteen of 21 retroclival collections were identifiable on MRI: 3 followed cerebral spinal fluid in signal intensity and 15 were bloody/proteinaceous. Additionally, 2 retroclival collections demonstrated a fluid-fluid level and 2 enhanced in the 5 children who received contrast material. Sagittal T1-weighted images, sagittal fluid-sensitive sequences, and axial FLAIR (fluid-attenuated inversion recovery) images showed the retroclival collections best. Retroclival collections were significantly correlated with supratentorial and posterior fossa subdural hematomas and were not statistically correlated with skull fracture or parenchymal brain injury. Retroclival collections, previously considered rare lesions strongly associated with accidental injury, were commonly identified in this cohort of children with abusive head trauma, suggesting that retroclival collections are an important component of the imaging spectrum in abusive head trauma. Retroclival collections were better demonstrated on MRI than CT, were commonly identified in conjunction with intracranial subdural hematomas, and were not significantly correlated with the severity of brain injury or with skull fractures.

MR Imaging of the Cervical Spine in Nonaccidental Trauma: A Tertiary Institution Experience

“…Injury of the tectorial membrane was uncommon in our group (3%) and has not been previously reported in the setting of NAT. 4,6 Although not evaluated with MR imaging, injury to the tectorial membrane may be inferred in the study by Silvera et al, 15 where 14% of their abusive head trauma cohort had retroclival epidural hemorrhage. Most of the ligamentous injuries in our cohort, as well as previously reported studies, 4,6 were cervical interspinous and nuchal ligament injuries.…”

Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas

“…The most comprehensive study to date identified retroclival hematoma in 32% of patients with AHT who were less than 3 years of age (50). Hemorrhage may occur anterior or posterior to the tectorial membrane, representing epidural and SDHs, respectively (Fig 18).…”

“…The most frequently associated finding is posterior fossa SDH along the occipital squama, but multifocal SDHs are also commonly seen. The presence of a retroclival hematoma may be a marker for craniocervical junction injury (50).…”

Isolated traumatic retroclival hematoma: case report and review of literature

“…We report a pediatric patient who sustained a retroclival hematoma (with both subdural and epidural components) after a motor vehicle crash and provide a review of the available English literature, emphasizing the pathophysiology of injury and the appropriate clinical management. There have been only 2 prior cases where both epidural and subdural hematoma co-present [ 9 ].…”