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Vol. 22. Issue 4.
Pages 337-341 (January 2011)
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Vol. 22. Issue 4.
Pages 337-341 (January 2011)
Paresia VI par craneal por hematoma subdural retroclival y espinal postraumático: Presentación de un caso y revisión de la literatura
Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and literature review
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I. Catalá-Antúnez
Corresponding author
icatala@santpau.cat
tuckim@hotmail.com

Correspondencia: Hospital de la Santa Creu i Sant Pau Departamento de Neurocirugía. C/ Sant Quintín n° 89. 08041 Barcelona.
, C. de Quintana-Schmidt, P. Clavel-Laria, G. Montes-Graciano, J. Molet-Teixidó
Servicio de Neurocirugía. Hospital de la Santa Creu i Sant Pau. Barcelona
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Resumen
Introducción

Los hematomas retroclivales postrau-máticos son extremadamente infrecuentes y casi exclusivos de la edad pediátrica. Únicamente se ha documentado en la literatura un caso de hematoma subdural retroclival postraumático.

Caso clínico

Varón de 8 años de edad que tras accidente de bicicleta sufre traumatismo cráneo-encefálico con hiperextensión cervical. A su ingreso presentó Glasgow inicial de 13 y diplopia por paresia del VI par derecho. En la TAC y RM cráneo-cervical se objetivó un hematoma subdural retroclival. Se realizó manejo conservador con colocación de collarín rígido. Se observó recuperación espontánea del VI par a los 6 días presentando únicamente cervicalgia al alta. Presentó resolución clínica y radiológica a los 3 meses del accidente.

Conclusión

Las lesiones hemorrágicas retroclivales postraumáticas son típicas de la edad pediátrica por la inmadurez de la unión cráneo-cervical que presentan. El tratamiento de elección es la colocación de un collarín rígido aunque si existe progresión clínica puede ser necesaria la evacuación quirúrgica.

Palabras clave:
Hematoma retroclival
Epidural
Subdural
Traumatismo cráneo-encefálico
Paresia abducens
Summary
Introduction

Retroclival posttraumatic hematomas are extremely rare and almost exclusive to childhood. Only one case of retroclival subdural hematoma has been reported in the literature to date.

Case report

An 8-year-old boy suffered a severe head injury with cervical hyperextension as the result of a bicycle accident. On admission his initial Glasgow Coma Score was 13 and he had diplopia due to right palsy of the VI nerve. A retroclival subdural hematoma was observed by CT and MRI of the craneovertebral junction. Management was conservative and a rigid collar was placed. Palsy of VI nerve recovered spontaneously at 6 days and at discharge the patient had only cervical pain. Follow up at 3 months after the accident showed clinical and radiological resolution.

Conclusion

Traumatic retroclival hematomas are mainly a pediatric entity due to immaturity of the cranio-cervical junction. Treatment consists of placement of a rigid collar although clinical progression may require surgical evacuation.

Key words:
Retroclival hematoma
Epidural
Subdural
Head trauma injury
Abducens nerve palsy

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