Isolated traumatic retroclival interdural hematoma causing craniocervical instability: A case report of pathology in a rare location and literature review

Abstract

Introduction. Retroclival hematomas (RCH) are a rare entity primarily as a post-traumatic phenomenon in the pediatric population. We present a case of Retroclival interdural hematoma in a 12 y/o female with a previous record of craniocervical trauma. A RCH is identified initially by CT and easily overlooked. MRI cervical spine to evaluate the Tectorial membrane and other craniocervical ligaments integrity. Case report. A 12-year-old female presented with bilateral abducens nerve palsies and a Glasgow Coma Score (GCS) of 13 following a high-speed motor vehicle accident. Initial CT brain revealed an infra-tentorial extra-axial focal hyperdense collection (hemorrhage) along the retroclival region in the interdural space measuring approximately 9 × 29 × 58 mm. Subsequent imaging and evaluations suggested cranio-cervical instability, leading to surgical intervention. Conclusions. Prompt diagnosis of RCH with conservative or surgical management is essential to avoid neurological deficits and mortality. Despite the significant potential for morbidity and mortality, the majority of patients show a benign clinical course with conservative care, underscoring the importance of quick diagnosis and close observation.