Outcome of Traumatic bilateral basal ganglia Hemorrhage: Rarest entity: Prospective study of five cases: Single institutional Experience

Abstract

Traumatic Basal ganglia hemorrhage is rare entity but bilateral basal ganglia hematoma after trauma is extremely rare and is limited to case reports. We describe five cases of traumatic bilateral basal ganglia hemorrhage, and its outcome and management. All Cases were managed conservatively. The general incidence of TBGH is reported between 2.4-3% of closed head injury. However, the incidence is higher in post mortem studies (9.8%). Five consecutive patients of TBGH, shown in initial Noncontrast CT (NCCT) head, admitted in our institute from August 2013 to August 2016, during this period total patient admitted of head injury is 1061 so incidence of Traumatic bilateral basal ganglia Hemorrhage in our series is 0.47% which is very less compare to previous literature formed the prospective study group. There were 3 males and 2 females; age ranging from 20 to 45 years (average 30 years).Hypertensive patients, drugs abuse history, history of coagulopathy with doubtful history of trauma or unknown mode of injury was excluded from the study. All patients had sustained road traffic accidents. NCCT head done of all patients after initial resuscitation. GCS at admission were 9 to 12 (mean 10.4), Outcome assessed by Glasgow outcome Score. All patients outcome was good. Average follow up 8.54 months.

Isolated bilateral, large, basal ganglia haemorrhage following a traumatic brain injury: A case report

“… 3 , 13 Bilateral TBGH is extremely rare and a limited number of cases have been reported. 4 – 9 Although the mechanism of TBGH remains unclear, two hypotheses have been suggested, namely spontaneous, or traumatic haemorrhage. According to the spontaneous haemorrhage hypothesis, it is thought that the basal ganglia is a region predisposed to hypertensive haemorrhage.…”

“… 3 , 15 While TBGHs are thought to be small, multiple, sometimes bilateral, and located in the zone of lentiform nucleus and external capsule, spontaneous haemorrhages are believed to be solitary and in the region of the thalamus and internal capsule. 7 …”

“… 11 By contrast, other studies in smaller numbers of patients have found favourable outcomes in all patients with no mortality. 5 , 7 , 13 …”

“… 3 Bilateral TBGHs are extremely rare. 4 – 9 Although the pathophysiology remains unclear, some theories suggest that the condition may arise from sudden acceleration or deceleration forces that result in shearing of the lenticulostriate or anterior choroidal arteries. 4 , 10 Most cases are managed conservatively and the outcome is variable.…”

“… 4 , 10 Most cases are managed conservatively and the outcome is variable. 7 , 11 Cognitive function may be affected and poor prognosis has been reported to be related to advanced age, associated intraventricular haemorrhage, ventilator dependence, large hematomas (volume >20 ml), poor Glasgow Coma Scale (GCS) on admission, and diffuse axon injury (DAI). 9 , 11 Here we describe a 63-year-old female patient with an isolated bilateral, large, basal ganglia haemorrhage secondary to a road traffic accident.…”