Spontaneous retroclival hematoma in pituitary apoplexy: case series

Abstract

OBJECT Pituitary apoplexy is a rare and potentially life-threatening disorder that is most commonly characterized by a combination of sudden headache, visual disturbance, and hypothalamic/hormonal dysfunction. In many cases, there is hemorrhagic infarction of an underlying pituitary adenoma. The resulting clinical symptoms are due to compression of the remaining pituitary, cavernous sinuses, or cranial nerves. However, there are only 2 case reports in the literature describing spontaneous retroclival expansion of hemorrhage secondary to pituitary apoplexy. Ten cases of this entity with a review of the literature are presented here. METHODS This is a single-institution retrospective review of 2598 patients with sellar and parasellar masses during the 10-year period between 1999 and 2009. The pituitary and brain MRI and MRI studies were reviewed by 2 neuroradiologists for evidence of apoplexy, with particular attention given to retroclival extension. RESULTS Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma. CONCLUSIONS Retroclival hemorrhage was seen in the majority of cases of pituitary apoplexy (56%), suggesting that it is more common than previously thought.

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

“…[ 9 14 ] Retroclival hematomas may also be spontaneous due to coagulopathy and have been associated with intraventricular and subarachnoid hemorrhage. [ 15 16 ] Almost all subarachnoid hemorrhages isolated to the anterior brainstem cisterns are angiography-negative,[ 17 18 ] showing that the venous structures of this region have the potential to bleed spontaneously or after trauma. The location of bleeding in the retroclival region is important with respect to hematoma expansion.…”

Pituitary apoplexy presenting as a peripheral rim enhancing parasellar mass lesion with dural enhancement along the tentorium

“…7 Retroclival haematoma in cases of PA has been documented by few authors. 14 It has been opined that a defect in the dorsum allowed the blood to extravasate into the retroclival epidural space. 15…”

Isolated traumatic retroclival hematoma: case report and review of literature

“…A common etiology is pituitary apoplexy. Hemorrhage can spread through the diaphragm sella into the subdural space, constrained by the posterior arachnoid membrane of the prepontine cistern [ 1 , 23 ]; on the other hand, a defect in the dorsum can permit blood flow into the epidural space [ 24 ]. Rare cases of rcSDH have been associated with aneurysmal rupture [ 25 , 26 ].…”