A case of retroclival epidural hematoma with acute obstructed hydrocephalus

Abstract

Retroclival epidural hematoma, which usually occurs secondary to head trauma caused by a high–velocity force in pediatric patients, is a relatively rare entity. We report here the case of a 9–year–old boy who was involved in a motor vehicle accident. His level of consciousness on admission was 15 on the Glasgow Coma Scale, although with palsy of bilateral hypoglossal nerves. Initial computed tomography (CT) scan revealed retroclival epidural hematoma and traumatic subarachnoid hemorrhage (tSAH) in the basal cistern and other cisterns around the brainstem. Two hours of observation in the intensive care unit revealed progressive deterioration of his level of consciousness combined with left abducens palsy. Follow–up CT scan at the time demonstrated a significant increase in the hematoma and tSAH, along with ventricular enlargement, suggestive of obstructed hydrocephalus, which required emergency surgery for placement of an external ventricular drain (EVD). After removal of the EVD on the fourth postoperative day, he showed good recovery from the acute obstructed hydrocephalus, and the head trauma was further treated conservatively by cervical fixation using a neck collar. This case suggests that we should be aware of the possibility of acute obstructed hydrocephalus in cases with a considerable volume of retroclival epidural hematoma, and should perform intensive monitor­ing of neurological status in the first several hours.