title: Spontaneous retroclival hematoma: a case series.
abstract: OBJECTIVE
  Retroclival hematomas are rare, appearing mostly as posttraumatic phenomena in children. Spontaneous retroclival hematoma (SRH) in the absence of trauma also has few descriptions in the literature. None of the reported clinical cases features the combination of an SRH and intraventricular hemorrhage (IVH). Nevertheless, despite extensive cases of idiopathic or angiographically negative subarachnoid hemorrhage (SAH) of the posterior fossa, only a single case report of a patient with a unique spontaneous retroclival hematoma has been identified. In this study, the authors reviewed the presentation, management, and clinical outcome of this rare entity.
  
  
  METHODS
  The authors performed a retrospective analysis of all patients with diagnosed SRH at their institution over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed.
  
  
  RESULTS
  Four patients had SRH. All were appropriately evaluated for coagulopathic and/or traumatic etiologies of hemorrhage, though no etiology could be found. Moreover, all of the patients demonstrated SRH that both clearly crossed the basioccipital synchondrosis and was contained within a nondependent configuration along the retroclival dura mater.
  
  
  CONCLUSIONS
  Spontaneous retroclival hematoma, often associated with IVH, is a rare subtype of intracranial hemorrhage frequently recognized only when MRI demonstrates compartmentalization of the posterior fossa hemorrhage. When angiography fails to reveal an underlying lesion, SRH patients, like patients with traditional angiographically negative SAH, enjoy a remarkably good prognosis.
authors.affiliation: Divisions of 1 Neuroradiology and.
authors.forename: Jared
authors.initials: J
authors.lastname: Narvid
authors.affiliation: Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Amans
authors.affiliation: Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Cooke
authors.affiliation: Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hetts
authors.affiliation: Divisions of 1 Neuroradiology and.
authors.forename: William P
authors.initials: WP
authors.lastname: Dillon
authors.affiliation: Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Higashida
authors.affiliation: Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Dowd
authors.affiliation: Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Van V
authors.initials: VV
authors.lastname: Halbach
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D046648:Hematoma, Subdural, Intracranial / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: IVH = intraventricular hemorrhage; MRA = MR angiography; SAH = subarachnoid hemorrhage; SRH = spontaneous retroclival hematoma; clivus; intracranial hematoma; subarachnoid hemorrhage; vascular disorders