Clinical Neurology and Neurosurgery 108 (2005) 67–72
Case report
Retroclival epidural hematoma secondary to
a longitudinal clivus fracture
Konstantinos N. Paterakis
a,∗
, Apostolos H. Karantanas
b
, Georgios M. Hadjigeorgiou
c
,
Vassilios Anagnostopoulos
a
, Antonios Karavelis
a
a
Department of Neurosurgery, Larissa University Hospital, Mesourlo, Larissa 411 10, Greece
b
Department of CT-MRI, Larissa General Hospital, 1 Tsakalof Str., Larissa 412 21, Greece
c
Department of Neurology, Larissa University Hospital, Larissa 411 10, Greece
Received 12 February 2004; received in revised form 12 October 2004; accepted 9 November 2004
Abstract
Retroclivalepiduralhematomas(RCEDH)make part ofposterior fossa epiduralhematomas (PFEDH) andrepresent an extremelyrare entity
not always easily diagnosed with computerized tomography (CT) due to beam hardening artifacts. The authors present a case of a child-to our
knowledge—thefirst reported until now—featuredthe rare combination of a longitudinal clivusfracture associated with concomitant epidural
hematoma treated conservatively with favorable outcome of the patient.
© 2004 Elsevier B.V. All rights reserved.
Keywords: Head injury; Epidural hematoma; Posterior fossa; Clivus; MR imaging
1. Introduction
Osteoligamentous injuries at the craniocervical junction
areusuallyindicativeofhigh-energytraumaandmostofthem
result in instantaneous death [1]. Association of these lesions
with posterior fossa epidural hematomas (PFEDH) and sur-
vival has been reported only in a limited number of patients
and can be easily undiagnosed if further investigation with
MR imaging (MRI) or high resolution computerized tomog-
raphy (CT) scan is not undertaken [2–5]. Clivus fractures al-
though less rare than previously believed are well known and
recognized entities in craniocervical junction injuries. Retro-
clival epidural hematomas (RCEDH) are rare with only nine
cases been documented in the literature [2–10]. The combi-
nation of both entities is considered to be extremely rare and
to date only one case of transverse clivus fracture associated
with retroclival hematoma has been described [6]. Longitu-
dinal clivus fracture with concomitant RCEDH, to the best
∗
Corresponding author. Tel.: +30 2410682739; fax: +30 2410670106.
E-mail address: kpaterakis@yahoo.com (K.N. Paterakis).
of our knowledge, has not been described in the literature
previously.
2. Case report
A 10-year-old boy involved in a motor vehicle accident
was admitted in our department after having suffered a head
injury. He was sitting in the back seat and struck his head
on the driver’s panel. On admission, according to Glasgow
Coma scale (GCS), his neurological status was assessed as
13/15(E4,M5,V4).Thephysicalexaminationshowedaright
paresisofsixth andninthcranialnerves.ACTscanrevealeda
post-traumatic subarachnoid hemorrhage in the right parietal
region. A coexistent Pipkin fracture of the right femoral head
was treated with traction.
On day 2, as his consciousness level showed a deterio-
ration (GCS 12/15) a new CT scan was undertaken with no
additional findings. His clinical condition remained stable
and in order to rule out a brain stem or diffuse axonal injury
heunderwent,onday7,an MRIthatdisclosedthe presenceof
a retroclival epidural hematoma (RCEDH) extending down
0303-8467/$ – see front matter © 2004 Elsevier B.V. All rights reserved.
doi:10.1016/j.clineuro.2004.11.010