Abstract

Retroclival epidural hematoma (EDH) is a rare form of intracranial hemorrhage located between the clivus and the dura mater, predominantly affecting pediatric patients due to the anatomical vulnerability of the craniocervical junction. This case report describes a 4-year-old boy involved in a motorcycle accident who presented with facial trauma and was found to have a retroclival EDH and multiple mandibular fractures. Despite the hematoma measuring 8.7 mm in thickness and 3 cc in volume, the patient remained neurologically intact with a Glasgow Coma Scale of 15. He underwent surgical repair for the mandibular fractures while the retroclival EDH was managed conservatively. The patient recovered fully without neurological deficits at follow-ups extending to 6 months. A comprehensive literature review reveals that retroclival EDH in children is commonly associated with high-energy trauma such as motor vehicle accidents and often results from tectorial membrane stripping injury. While clinical presentations vary, many cases, like the one described, show minimal neurological signs despite the presence of significant hematomas, emphasizing the importance of high clinical suspicion and appropriate neuroimaging. Computed tomography is the initial diagnostic tool, but magnetic resonance imaging is superior for identifying associated ligamentous injuries and differentiating from subdural hematomas. Most pediatric retroclival EDH cases are managed conservatively with excellent outcomes, reserving surgical intervention for cases involving brainstem compression or craniocervical instability. This report reinforces the favorable prognosis of isolated retroclival EDH in neurologically stable pediatric patients and underscores the critical role of imaging and clinical vigilance in trauma assessment.

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