Clival fracture

Case contributed by Dr Antonio Rodrigues de Aguiar Neto

Presentation

This patient was admitted to the emergency room as a motor vehicle accident victim, evolving with vomiting, drowsiness, and disorientation.

Patient Data

Age: 30 years
Gender: Female
CT

CT scans demonstrate a centrally transverse fracture line extending through the basiocciput (clivus) associated with occipital skull vault fractures. CT also reveals right frontal subdural hematoma, left parietal subarachnoid hemorrhage, hemorrhagic contusions in frontal lobe bilaterally, brain edema, and sphenoid hemosinus.

Impression: Traumatic brain injury with skull vault fractures and a transverse clival fracture, associated with intracranial hemorrhage.

Case Discussion

Clival fractures are uncommon skull base fractures 1-5. CT pattern has predictive value about prognostic; therefore, radiologists working in the emergency department should be able to identify the types of fractures of the clivus and alert clinicians to their complications 1-5. This case illustrates a high-energy head trauma with a transverse clival fracture, a fracture of the occipital bone, and an intracranial hemorrhage.

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