A rare case of retroclival epidural hematoma: case report and review of the literature

Abstract

Retroclival epidural hematomas (REDHs) are rare and almost exclusively found in the pediatric age group. Frequently, the etiology is related to accidental trauma, though other mechanisms have been observed, including coagulopathy, non-accidental trauma, and pituitary apoplexy. A 76-year-old man was admitted to our emergency department after a loss of consciousness. He presented with a Glasgow Coma Scale of 13(E3V4M6). He complained of headache accompanied by nausea and vomiting. A computer tomography (CT) revealed a hemorrhage along the clivus and dens. Magnetic resonance imaging (MRI) demonstrated the retroclival hematoma in epidural space. At discharge headache resolved without medical or operative intervention. REDHs are likely underdiagnosed in adults and magnetic resonance imaging is superior for identifying these lesions. Atlanto-occipital dislocation should be considered in all cases of REDH. Most cases exhibit a benign clinical course with conservative management, surgical management is dictated based on the presence of hydrocephalus, brainstem compression, and occipitocervical instability.

Keywords: CT scan; Clivus; Epidural; Haematoma; MRI.