Occipital condyle fractures and clivus epidural hematoma. Case report

A 47-year-old woman presented with a rare case of epidural hematoma of the clivus. The patient had bilateral occipital condyle fractures (a comminuted fracture on the right side, an avulsion fracture on left side and a lower clivus fracture). On admission the patient was tetraparetic with left abduc ens palsy. Preoperative imaging showed no atlanto-axial or occipito-atlanta l dislocation. The patient was operated with a posterior approach. An occipital craniectom y with C1 laminectomy was achieved without atlanto-occipital fusion. Two years after the trauma, the patient had mild left hemiparesis but was a ble to walk normally. Head motion was normal, but just mildly decreased by pain in flexion and extension. Imaging control did not show any occipito-at lantal instability. We describe the imaging features allowing precise diagn osis and discuss the management of a rare entity : bilateral occipital cond yle fractures and epidural hematoma of the clivus.