Retroclival Epidural Hematoma in a Child Affected by Whiplash Cervical Injury: A Typical Case of a Rare Condition

Souza, Rodrigo Becco de; Aguiar, Guilherme Brasileiro de; Santos, Marcelo Eduardo Sette dos; Acioly, Marcus André

doi:10.1159/000335446

Cited by 11 publications

(2 citation statements)

References 24 publications

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“…Children who have suffered TBI usually present with minor symptoms which do not require neurosurgical interventions [1]. Posterior fossa lesions are even more uncommon, but, when present, are usually described as epidural hematomas [2]. Of this lesion type, some cases have been reported in literature that describe retroclival epidural hematoma, which causes several neurological manifestations, including bilateral abducens palsy.…”

Section: Introductionmentioning

confidence: 99%

Retroclival Pneumocephalus Associated with Bilateral Abducens Palsy in a Child

Paiva

Aguiar²,

Ferraz³

et al. 2016

Pediatr Neurosurg

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Traumatic brain injury (TBI) is less common in children than in adults. Posterior fossa lesions are even more uncommon, but, when present, are usually epidural hematomas. These lesions, even when small, may have a bad outcome because of the possibility of compression of the important structures that the infratentorial compartment contains, such as the brainstem and cranial nerves, and the constriction of the fourth ventricle, causing acute hydrocephalus. Although unusual, posterior fossa lesions are increasingly being diagnosed because of the better quality of and easier access to cranial tomography. In this paper, we report a case of a 12-year-old male patient who had suffered a TBI and presented with several pneumocephali, one of them in the retroclival region, causing a mass effect and then compression of the sixth cranial nerve which is the most susceptible to these injuries. We discuss these traumatic posterior fossa lesions, with an emphasis on retroclival pneumocephalus, not yet described in the literature in association with bilateral abducens palsy. In addition, we discuss associated lesions and the trauma mechanism.

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Section: Introductionmentioning

confidence: 99%

Retroclival Pneumocephalus Associated with Bilateral Abducens Palsy in a Child

Paiva

Aguiar²,

Ferraz³

et al. 2016

Pediatr Neurosurg

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“…Neurological abnormalities observed in accidentally injured children with retroclival collections may be related to localized injury to posterior fossa contents with stretching, direct compression or contusion of nerves and brain tissue. In addition, deficits may reflect broader injury to the central nervous system [33]. Correlating neurological deficits in abused infants to retroclival epidural or subdural collections can be especially challenging, particularly when there is polytrauma with additional intracranial injuries in a sedated/intubated patient.…”

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confidence: 99%

Retroclival collections associated with abusive head trauma in children

et al. 2014

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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.

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Isolated traumatic retroclival hematoma: case report and review of literature

2016

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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.

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Retroclival Epidural Hematoma in a Child Affected by Whiplash Cervical Injury: A Typical Case of a Rare Condition

Cited by 11 publications

References 24 publications

Retroclival Pneumocephalus Associated with Bilateral Abducens Palsy in a Child

Retroclival Pneumocephalus Associated with Bilateral Abducens Palsy in a Child

Retroclival collections associated with abusive head trauma in children

Isolated traumatic retroclival hematoma: case report and review of literature

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