Retroclival hematoma

A retroclival hematoma is a collection of blood located along the dorsum sellae and clivus which may reach the dens. It has been classified into either an epidural or subdural retroclival hematoma depending on the anatomical location of the blood accumulation.

Epidemiology

It is an uncommon finding and few cases have been reported .

Clinical presentation

Symptoms are those of brain stem compression and patients may present with:

• headache
• depressed conscious state
• seizures
• cranial nerve palsies
• cardiac arrest

Pathology

Etiology

It is frequently reported in the setting of trauma, but other causes exist :

• pituitary apoplexy
• aneurysmal rupture
• thrombocytopenia
• hemophilia
• oral anticoagulant overdose
• posterior fossa decompressive craniectomy
• spontaneous intracranial hypotension

Treatment and prognosis

Significant compression of the brain stem requires surgical evacuation. Otherwise, the treatment depends on etiology, and conservative management gives good results since most patients recover with minimal long-term neurological complications.

Differential diagnosis

• beam hardening artifact in the posterior fossa may mimic this appearance