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A retroclival hematoma is a collection of blood located along the dorsum sellae and clivus which may reach the dens. It has been classified into either an epidural or subdural retroclival hematoma depending on the anatomical location of the blood accumulation.
It is an uncommon finding and few cases have been reported 2.
Symptoms are those of brainstem compression and patients may present with:
- depressed conscious state
- cranial nerve palsies
- cardiac arrest
It is frequently reported in the setting of trauma, but other causes exist 4:
- pituitary apoplexy
- aneurysmal rupture
- oral anticoagulant overdose
- posterior fossa decompressive craniectomy
- spontaneous intracranial hypotension
Treatment and prognosis
Significant compression of the brainstem requires surgical evacuation. Otherwise, the treatment depends on etiology, and conservative management gives good results since most patients recover with minimal long-term neurological complications.
- beam hardening artifact in the posterior fossa may mimic this appearance
- 1. Nguyen HS, Shabani S, Lew S. Isolated traumatic retroclival hematoma: case report and review of literature. (2016) Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 32 (9): 1749-55. doi:10.1007/s00381-016-3098-y - Pubmed
- 2. Piccirilli M, Paglia F, Tropeano MP. A rare case of retroclival epidural hematoma: case report and review of the literature. (2019) Acta neurologica Belgica. doi:10.1007/s13760-019-01238-9 - Pubmed
- 3. Catalá-Antúnez I, de Quintana-Schmidt C, Clavel-Laria P, Montes-Graciano G, Molet-Teixidó J. [Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and literature review]. (2011) Neurocirugia (Asturias, Spain). 22 (4): 337-41. Pubmed
- 4. Zabalo G, Ortega R, Díaz J, Vázquez A, de Frutos D, García JC, Zazpe I. Retroclival epidural haematoma: a diagnosis to suspect. Report of three cases and review of the literature. (2017) Acta neurochirurgica. 159 (8): 1571-1576. doi:10.1007/s00701-017-3214-0 - Pubmed