A Major Pitfall to Avoid: Retroclival Hematoma due to Odontoid Fracture

Datar, Sudhir; Daniels, David J.; Wijdicks, Eelco F. M.

doi:10.1007/s12028-013-9831-4

Cited by 8 publications

(10 citation statements)

References 19 publications

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“…[4] Diagnostic studies for retroclival hematomas include magnetic resonance (MR) and CT evaluations to best document the extent of posterior fossa hemorrhage and intra- or extra-dural retroclival hematoma, along with craniovertebral ligament injuries, clot migration, and/or occipitocervical fractures. [2,3]…”

Section: Discussionmentioning

confidence: 99%

“…[1] They are typically classified as epidural or subdural and are often associated with cervical spine and/or clivus fractures. [3] Many patients present with sixth cranial nerve palsies that typically recover. Rarely, patients require posterior fossa decompression, cervical fusion, and/or occipitocervical fusion (e.g., if an odontoid fracture is also present).…”

Section: Introductionmentioning

confidence: 99%

“…Rarely, patients require posterior fossa decompression, cervical fusion, and/or occipitocervical fusion (e.g., if an odontoid fracture is also present). [3,4,6] Here, we present a 35-year-old male who did well following a traumatic brain injury, resulting in a retroclival hematoma extending to the C2 level that did not warrant surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

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Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review

Solorio-Pineda

Nieves-Valerdi

Franco-Jiménez

et al. 2019

Surgical Neurology International

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Background: Retroclival hematomas are rare and occur mostly in the pediatric population. They are variously attributed to trauma, apoplexy, and vascular lesions. With motor vehicle accidents (MVAs), the mechanism of traumatic injury is forced flexion and extension. There may also be associated cervical spinal and/or clivus fractures warranting fusion. Case Description: A 35-year-old male sustained a traumatic brain injury after a fall of 5 m at work. His Glasgow coma scale (GCS) on admission was 13 (M6V3O4). He had no cranial nerve deficits. The brain computed tomography (CT) showed a retroclival subdural hematoma that extended to the C2 level. Conclusions: Most retroclival hematomas are attributed to MVAs, and cranial CT and magnetic resonance studies typically demonstrate a combination of posterior fossa hemorrhage with retroclival hematomas (intra or extradural). Patients with retroclival hematomas but high GCS scores on admission usually have better prognoses following traumatic brain injuries attributed to MVA. Notable however is the frequent association with additional cervical and/or craniocervical injuries (e.g. such as odontoid fracture) that may warrant surgery/fusión.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review

Solorio-Pineda

Nieves-Valerdi

Franco-Jiménez

et al. 2019

Surgical Neurology International

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“…The possibility of brainstem compression or instability mandates initial close observation, reasonably within an ICU setting [ 30 ]. Although rare, the extra-axial hematoma can cause mass effect on the brainstem and cranial nerves, necessitating surgical evacuation [ 19 , 35 , 37 , 38 ]. Of the 33 traumatic cases of rcEDH, twelve patients exhibited a cranial nerve palsy, five patients required surgical stabilization of the craniocervical junction [ 19 , 38 , 39 ], one patient required an external ventricular drain for progressive hydrocephalus [ 20 ], and six patients died.…”

Section: Discussionmentioning

confidence: 99%

“…Except for the rare cases that lead to death [ 17 , 18 , 20 , 28 , 29 , 37 , 39 ], the majority of patients exhibit good outcomes with minimal long-term neurological deficits with conservative management. Tubbs et al [ 39 ] noted no relationship between hematoma size and presenting symptoms; moreover, initial GCS did not correlate with outcomes.…”

Section: Discussionmentioning

confidence: 99%

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 haematoma: a diagnosis to suspect. Report of three cases and review of the literature

et al. 2017

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Retroclival epidural haematoma (REDH) has been reported infrequently. It is a rare entity which is probably underdiagnosed. It is most commonly seen in the paediatric population and is generally associated with high-velocity injuries. We report three cases of paediatric patients diagnosed with REDHs: two of them secondary to high-energy trauma related to a motor-vehicle accident and the other a low-energy trauma after a slip while playing football. All three patients were managed conservatively by cervical immobilisation with favourable outcome. REDH is probably underdiagnosed by computed tomography scan. When the suspicion is high, sagittal reconstructions or magnetic resonance imaging should be considered to confirm the diagnosis. Usually, it is related to hyperflexion or hyperextension cervical injuries secondary to motor vehicle accident. However, it can also be observed in milder injuries.

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A Major Pitfall to Avoid: Retroclival Hematoma due to Odontoid Fracture

Cited by 8 publications

References 19 publications

Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review

Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review

Isolated traumatic retroclival hematoma: case report and review of literature

Retroclival epidural haematoma: a diagnosis to suspect. Report of three cases and review of the literature

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