Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision

Mohamed Awad Mohamed Hassan; Alfadil Osman Alawaad; Ghalib Almesedin; Saggaf Alawi Assaggaf

doi:doi:10.11648/j.ijn.20210501.19

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Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision

Mohamed Awad Mohamed Hassan, Alfadil Osman Alawaad, Ghalib Almesedin, Saggaf Alawi Assaggaf

Published in International Journal of Neurosurgery (Volume 5, Issue 1)

Received: 24 April 2021 Accepted: 8 May 2021 Published: 27 May 2021

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Abstract

Background and Importance: Bilateral occipital condyle fracture (OCF) is a rare type of injury that occurs at the occipitocervical junction, mostly due to high energy trauma to cranium with axial loading. These fractures are difficult to diagnose based on conventional cervical or cranial radiography and they have non-specific clinical manifestations. However, unstable fractures carry the most risk for morbidity and mortality due to their close relation to important neural and vascular structures. Acute retro-clival subdural hematoma (rcSDH) is a collection of blood dorsal to the tectorial membrane, which is a critical structure for maintaining occipitocervical stability, presence of posttraumatic acute retroclival subdural hematoma in the setting of non-displaced bilateral occipital condyle fractures in traumatic patients is a marker of high energy trauma with fatal course in acute setting due to compression on subarachnoid space by acute hematoma and subsequent increase intracranial pressure and a merely marker of occipitocervical instability due to injury/damage to tectorial membrane. We describe the imaging features and clinical symptoms and signs that led to the diagnosis and classification of stable bilateral OCFs with a quickly resolving rcSDH in a previously healthy man aged 25 years involved in a motor vehicle accident, allowing conservative management. The co-existing of both injuries has not been described in the literature to the best of our knowledge.

Published in	International Journal of Neurosurgery (Volume 5, Issue 1)
DOI	10.11648/j.ijn.20210501.19
Page(s)	38-41
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Occipital Condyle Fractures, Subdural Hematoma, Clivus Hematoma, Occipitocervical, Severe Head Injury, Atlantooccipital Dislocation

References

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[2]	Sudhir D, David D, Eelco FM, Wijdicks A. Major Pitfall to Avoid: Retroclival Hematoma due to Odontoid Fracture. J Neurocrit Care. 2013; 19 (2): 206.
[3]	Leone A, Cerase A, Colosimo C, Lauro L, Puca A and Marano P. Occipital condylar fractures: a review. Radiology 2000; 216 (3): 635-644,
[4]	Tubbs RS, Hallock JD, Radcliff V, et al. Ligaments of the craniocervical junction. J. Neurosurg. 2011; 14: 697-709.
[5]	Kao SC, Waziri MH, Smith WL, Sato Y, Yuh WT, Franken EA Jr. MR imaging of the craniovertebral Junction, Cranium and brain in children with Achondroplasia. Am J Roentgenol. 1989; 153 (3): 565-565.
[6]	Casey D, Chaudhary BR, Leach PA, Herwadkar A, Karabatsou K. Traumatic clival subdural hematoma in an adult. J Neurosurg 2009; 110: 1238–1241.
[7]	Koshy J, Scheurkoye1 MM, Clough L, Huisman TA, Poretti. A, Bosmani T. Neuroimiging finding of retroclival hemorrhage in children: a diagnostic conundrum. Child Nerv Syst. 2014; 30: 835-839.
[8]	Capuano C, Costagliola C, Shamsaldin M, Maleci A, Di Lorenzo N: Occipital condyle fractures: A hidden nosologic entity. An experience with 10 cases. Acta Neurochir (Wien) 2004; 146: 779-784.
[9]	Anderson PA and Montessano PX. Morphology and treatment of occipital condyle fractures. Spine 1988; 13: 731-736.
[10]	Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Neurosurgery. 1997; 41: 368-377.
[11]	Mueller FJ, Fuechtmeier B, Kinner B, et al. Occipital condyle fractures. Prospective follow up of 31 cases within 5 years at a level1 htrauma centre. Euro Spine J 2012; 21; 289-94.
[12]	Martinez-del-Campo E, Kalb S. Soriano-Baron H, et al. Computed tomography parameters for atlanto-occiptal dislocation in adult patients: The occipital condyle-C1 interval. J Neurosurg Spine 2016; 24: 535-45.
[13]	Legros B, Fournier P, Chiaroni P, Ritz O, Fusciardi J, Basal Fracture Of The Skull And Lower (IX, X, XI, XII) Cranial Nerves Palsy: Four Case Reports Including Two Fractures Of Occipital Condyle- A Literature Review. J Trauma Inj Infect Crit Care 2000; 48 (2): 342-48.
[14]	Hanson JA, Deliganis AV, Baxter AB, et al. Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fracture in 95 patients. Am J Roentgenol. 2002; 178 (5): 1261-1268.
[15]	Aulino JM, Tutt LK, Kaye JJ, Smith PW, Morris JA Jr () Occipital condyle fractures: clinical presentation and imaging findings in 76 patients. Emerg Radiol 2005; 11 (6): 342–347.
[16]	Horn EM, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VK, Theodore N. Survivores of occipitoatlantal dislocation injuries.

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APA Style

Mohamed Awad Mohamed Hassan, Alfadil Osman Alawaad, Ghalib Almesedin, Saggaf Alawi Assaggaf. (2021). Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision. International Journal of Neurosurgery, 5(1), 38-41. https://doi.org/10.11648/j.ijn.20210501.19

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ACS Style

Mohamed Awad Mohamed Hassan; Alfadil Osman Alawaad; Ghalib Almesedin; Saggaf Alawi Assaggaf. Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision. Int. J. Neurosurg. 2021, 5(1), 38-41. doi: 10.11648/j.ijn.20210501.19

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AMA Style

Mohamed Awad Mohamed Hassan, Alfadil Osman Alawaad, Ghalib Almesedin, Saggaf Alawi Assaggaf. Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision. Int J Neurosurg. 2021;5(1):38-41. doi: 10.11648/j.ijn.20210501.19

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@article{10.11648/j.ijn.20210501.19,
  author = {Mohamed Awad Mohamed Hassan and Alfadil Osman Alawaad and Ghalib Almesedin and Saggaf Alawi Assaggaf},
  title = {Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision},
  journal = {International Journal of Neurosurgery},
  volume = {5},
  number = {1},
  pages = {38-41},
  doi = {10.11648/j.ijn.20210501.19},
  url = {https://doi.org/10.11648/j.ijn.20210501.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210501.19},
  abstract = {Background and Importance: Bilateral occipital condyle fracture (OCF) is a rare type of injury that occurs at the occipitocervical junction, mostly due to high energy trauma to cranium with axial loading. These fractures are difficult to diagnose based on conventional cervical or cranial radiography and they have non-specific clinical manifestations. However, unstable fractures carry the most risk for morbidity and mortality due to their close relation to important neural and vascular structures. Acute retro-clival subdural hematoma (rcSDH) is a collection of blood dorsal to the tectorial membrane, which is a critical structure for maintaining occipitocervical stability, presence of posttraumatic acute retroclival subdural hematoma in the setting of non-displaced bilateral occipital condyle fractures in traumatic patients is a marker of high energy trauma with fatal course in acute setting due to compression on subarachnoid space by acute hematoma and subsequent increase intracranial pressure and a merely marker of occipitocervical instability due to injury/damage to tectorial membrane. We describe the imaging features and clinical symptoms and signs that led to the diagnosis and classification of stable bilateral OCFs with a quickly resolving rcSDH in a previously healthy man aged 25 years involved in a motor vehicle accident, allowing conservative management. The co-existing of both injuries has not been described in the literature to the best of our knowledge.},
 year = {2021}
}

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TY  - JOUR
T1  - Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision
AU  - Mohamed Awad Mohamed Hassan
AU  - Alfadil Osman Alawaad
AU  - Ghalib Almesedin
AU  - Saggaf Alawi Assaggaf
Y1  - 2021/05/27
PY  - 2021
N1  - https://doi.org/10.11648/j.ijn.20210501.19
DO  - 10.11648/j.ijn.20210501.19
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 38
EP  - 41
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20210501.19
AB  - Background and Importance: Bilateral occipital condyle fracture (OCF) is a rare type of injury that occurs at the occipitocervical junction, mostly due to high energy trauma to cranium with axial loading. These fractures are difficult to diagnose based on conventional cervical or cranial radiography and they have non-specific clinical manifestations. However, unstable fractures carry the most risk for morbidity and mortality due to their close relation to important neural and vascular structures. Acute retro-clival subdural hematoma (rcSDH) is a collection of blood dorsal to the tectorial membrane, which is a critical structure for maintaining occipitocervical stability, presence of posttraumatic acute retroclival subdural hematoma in the setting of non-displaced bilateral occipital condyle fractures in traumatic patients is a marker of high energy trauma with fatal course in acute setting due to compression on subarachnoid space by acute hematoma and subsequent increase intracranial pressure and a merely marker of occipitocervical instability due to injury/damage to tectorial membrane. We describe the imaging features and clinical symptoms and signs that led to the diagnosis and classification of stable bilateral OCFs with a quickly resolving rcSDH in a previously healthy man aged 25 years involved in a motor vehicle accident, allowing conservative management. The co-existing of both injuries has not been described in the literature to the best of our knowledge.
VL  - 5
IS  - 1
ER  -

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Author Information

Mohamed Awad Mohamed Hassan

Neurosurgery Department, King Khalid Hospital, Hail, Kingdom of Saudi Arabia
Alfadil Osman Alawaad

Neurosurgery Department, King Khalid Hospital, Hail, Kingdom of Saudi Arabia
Ghalib Almesedin

Neurosurgery Department, King Khalid Hospital, Hail, Kingdom of Saudi Arabia
Saggaf Alawi Assaggaf

Neurosurgery Department, King Khalid Hospital, Hail, Kingdom of Saudi Arabia

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APA Style

Mohamed Awad Mohamed Hassan, Alfadil Osman Alawaad, Ghalib Almesedin, Saggaf Alawi Assaggaf. (2021). Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision. International Journal of Neurosurgery, 5(1), 38-41. https://doi.org/10.11648/j.ijn.20210501.19

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ACS Style

Mohamed Awad Mohamed Hassan; Alfadil Osman Alawaad; Ghalib Almesedin; Saggaf Alawi Assaggaf. Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision. Int. J. Neurosurg. 2021, 5(1), 38-41. doi: 10.11648/j.ijn.20210501.19

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AMA Style

Mohamed Awad Mohamed Hassan, Alfadil Osman Alawaad, Ghalib Almesedin, Saggaf Alawi Assaggaf. Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision. Int J Neurosurg. 2021;5(1):38-41. doi: 10.11648/j.ijn.20210501.19

Copy | Download

@article{10.11648/j.ijn.20210501.19,
  author = {Mohamed Awad Mohamed Hassan and Alfadil Osman Alawaad and Ghalib Almesedin and Saggaf Alawi Assaggaf},
  title = {Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision},
  journal = {International Journal of Neurosurgery},
  volume = {5},
  number = {1},
  pages = {38-41},
  doi = {10.11648/j.ijn.20210501.19},
  url = {https://doi.org/10.11648/j.ijn.20210501.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210501.19},
  abstract = {Background and Importance: Bilateral occipital condyle fracture (OCF) is a rare type of injury that occurs at the occipitocervical junction, mostly due to high energy trauma to cranium with axial loading. These fractures are difficult to diagnose based on conventional cervical or cranial radiography and they have non-specific clinical manifestations. However, unstable fractures carry the most risk for morbidity and mortality due to their close relation to important neural and vascular structures. Acute retro-clival subdural hematoma (rcSDH) is a collection of blood dorsal to the tectorial membrane, which is a critical structure for maintaining occipitocervical stability, presence of posttraumatic acute retroclival subdural hematoma in the setting of non-displaced bilateral occipital condyle fractures in traumatic patients is a marker of high energy trauma with fatal course in acute setting due to compression on subarachnoid space by acute hematoma and subsequent increase intracranial pressure and a merely marker of occipitocervical instability due to injury/damage to tectorial membrane. We describe the imaging features and clinical symptoms and signs that led to the diagnosis and classification of stable bilateral OCFs with a quickly resolving rcSDH in a previously healthy man aged 25 years involved in a motor vehicle accident, allowing conservative management. The co-existing of both injuries has not been described in the literature to the best of our knowledge.},
 year = {2021}
}

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TY  - JOUR
T1  - Traumatic Retroclival Subdural Hematoma on Top of Stable Bilateral Occipital Condyle Fracture: Impact of Hematoma on Craniocervical Stability and Management Decision
AU  - Mohamed Awad Mohamed Hassan
AU  - Alfadil Osman Alawaad
AU  - Ghalib Almesedin
AU  - Saggaf Alawi Assaggaf
Y1  - 2021/05/27
PY  - 2021
N1  - https://doi.org/10.11648/j.ijn.20210501.19
DO  - 10.11648/j.ijn.20210501.19
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 38
EP  - 41
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20210501.19
AB  - Background and Importance: Bilateral occipital condyle fracture (OCF) is a rare type of injury that occurs at the occipitocervical junction, mostly due to high energy trauma to cranium with axial loading. These fractures are difficult to diagnose based on conventional cervical or cranial radiography and they have non-specific clinical manifestations. However, unstable fractures carry the most risk for morbidity and mortality due to their close relation to important neural and vascular structures. Acute retro-clival subdural hematoma (rcSDH) is a collection of blood dorsal to the tectorial membrane, which is a critical structure for maintaining occipitocervical stability, presence of posttraumatic acute retroclival subdural hematoma in the setting of non-displaced bilateral occipital condyle fractures in traumatic patients is a marker of high energy trauma with fatal course in acute setting due to compression on subarachnoid space by acute hematoma and subsequent increase intracranial pressure and a merely marker of occipitocervical instability due to injury/damage to tectorial membrane. We describe the imaging features and clinical symptoms and signs that led to the diagnosis and classification of stable bilateral OCFs with a quickly resolving rcSDH in a previously healthy man aged 25 years involved in a motor vehicle accident, allowing conservative management. The co-existing of both injuries has not been described in the literature to the best of our knowledge.
VL  - 5
IS  - 1
ER  -

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