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Retroclival hematoma

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Treatment of multiple sclerosis (MS) for 13 years. Currently dizziness and confusion for 2 weeks. No history of trauma.

Patient Data

Age: 60 years
Gender: Male

Cervical spine

mri

Retroclival subacute hematoma is noted with a thickness of 0.7 cm.

Mild cervical spondylodegenerative changes.

Brain

mri

Bilateral extra-axial collections; right frontoparietal extra-axial collection with a thickness of 2.2 cm and left fronto-tempro-parietal extra-axial collection, with a thickness of 1 cm. They show high T1 and T2 signals with areas of diffusion restriction, exerting mass effect in the form of compression of the underlying brain parenchyma, reflecting bilateral subacute subdural hematomas.

Retroclival subacute hematoma is noted with a thickness of 0.7 cm.

Scattered high T2 signal white matter changes at centrum semiovale at both parietal lobes, suggestive of chronic white matter changes.

Case Discussion

This case of an old patient with a history of multiple sclerosis (MS) on chronic treatment. No current evidence of disease reactivation. The responsible pathology for the recent neurological manifestations is likely the spontaneous bilateral subacute subdural hematomas. 

Retroclival hematoma is also noted, an uncommon finding and location for subdural hematoma.  

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