Retroclival epidural hematoma: A rare location of epidural hematoma, case report, and review of literature

Abstract

Retroclival epidural hematoma in adults is uncommon. Although most cases are associated with craniocervical trauma, other mechanisms have been reported, such as coagulopathy, vascular lesions, and pituitary apoplexy. We report two adults diagnosed with retroclival epidural hematoma. One patient was an 89-year-old male with leukemia and thrombocytopenia who sustained a fall and developed a traumatic retroclival epidural hematoma with brainstem compression; surgery could not be performed due to his clinical condition and he died 5 days later. The other patient was a 78-year-old female with atrial fibrillation who developed a spontaneous retroclival epidural hematoma as a result of warfarin use; she was treated conservatively with anticoagulant reversal and methylprednisolone and was subsequently discharged without neurological deficit. Retroclival hematomas are primarily treated conservatively due to the difficulty of surgical approach. The bleeding mechanism and dural and venous anatomy of this region tend to limit hematoma expansion.

Traumatic retroclival hematoma complicated with hyponatremia and delayed traumatic intracranial hematoma in an adult: A case report

“…However, steroids may be administered due to their membrane-stabilizing effect, as venous and dural tension play a role in the bleeding mechanism. 13 Electrolyte imbalance is not an uncommon entity in head injury patients. Hyponatremia is a condition that may result from either syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting (CSW).…”

“…However, if the neurological condition worsens or there is craniocervical instability, surgery might be necessary. 13 With conservative management, most of the cases have good outcomes with minimal long-term neurological deficits, with the exception of a few cases 11 , 14 that result in death. 4 The duration of RH resorption can vary and there is no established treatment to accelerate the process.…”

“…However, steroids may be administered due to their membrane-stabilizing effect, as venous and dural tension play a role in the bleeding mechanism. 13 …”