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Spontaneous retroclival hematoma presenting as a thunderclap headache. Case report
W I Schievink1, R C Thompson, C T Loh
1Maxine Dunitz Neurosurgical Institute and Imaging Medical Group, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. schievinkw@cshs.org
Journal of Neurosurgery
|September 22, 2001
Summary
Thunderclap headaches can signal serious conditions. This case highlights spontaneous retroclival hematoma, a rare cause, which may present with normal CT scans, emphasizing its inclusion in differential diagnoses.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Thunderclap headache, characterized by instantaneous severe onset, necessitates prompt diagnosis due to potential life-threatening causes.
- Common differentials include aneurysmal subarachnoid hemorrhage, cerebral venous sinus thrombosis, and arterial dissections.
Observation:
- A 49-year-old woman presented with an excruciating, instantaneous headache.
- Initial head CT scans were unremarkable.
- Cerebrospinal fluid analysis revealed xanthochromia, and MR imaging of the cervical spine identified a retroclival hematoma.
Findings:
- Spontaneous retroclival hematoma, an uncommon intracranial hemorrhage, was diagnosed.
- Despite negative cerebral angiographic studies, the hematoma resolved spontaneously.
- The patient experienced an uneventful recovery.
Implications:
- Spontaneous retroclival hematoma is a rare but critical diagnosis in thunderclap headache presentations.
- Normal initial CT findings do not exclude serious intracranial pathology.
- This condition should be considered in the differential diagnosis of thunderclap headaches, particularly when CT is negative.
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