Traumatic basal ganglia hemorrhage

Abstract

Traumatic basal ganglia hemorrhage (TBGH) is probably secondary to rupture of lenticulostriate or anterior choroidal arteries. We evaluated 6 consecutive cases of this entity to define its clinical and pathologic dimensions. Relative frequency of TBGH was 3% (3 left, 3 right) in this acute rehabilitation population. Lesion size and associated pathology varied. Contralateral hemiparesis, present in all, recovered to varying extents, apparently related to lesion location (posterior limb, internal capsule, or midperiventricular white matter), not size. Prolonged muteness occurred in 4 of 6; these 4 patients also had severe diffuse axonal injury. Clinical findings corresponded with previously recognized subcortical hemisphere profiles. All achieved a moderate disability or good recovery rating on the Glasgow Outcome Scale. Rather than any features of the TBGH itself, duration of coma and/or associated temporal herniation predicted slower recovery and worse outcome. In conclusion, TBGH is a rare entity compatible with a favorable recovery, especially when occurring in isolation. The hemorrhage itself determines clinical signs related to particular subcortical structures involved and the side of the lesion. Overall cognitive impairment and speed and quality of recovery are more related to associated cerebral damage.

Pontine Infarction Induced by Injury of the Perforating Branch of the Basilar Artery After Blunt Head Impact -Case Report-

“…9,16) Axonal injury is occasionally associated with perforating branch injury, resulting in hemorrhage or infarction due to shearing force. 1,12) Therefore, shearing force to the paramedian branch of the basilar artery may have caused the cerebral infarction in this case.…”

Unstable Chest Surgical Management in Pregnancy: Case Report and Literature Review

“…Mosberg and Lindenberg, 4 in an autopsy of fatal head injury patient, demonstrated massive hematoma in the improvement in all patients managed conservatively. Kimura et al, 13 Katz et al, 3 and Jang et al 7 have also reported favorable outcomes for TBGH with conservative management. Surgical evacuation entails approach to the hematoma via the thalamoganglionic region, leading to further damage of the eloquent areas resulting in possible poor outcome.…”

“…[1][2][3] The patients with TBGH have increased incidence of coagulation abnormalities, diffuse axonal injury, intraventricular hemorrhage, and intra-/extraaxial bleed and have a correspondingly poor outcome. Since basal ganglia region is predisposed to hypertensive bleed, at times, it becomes difficult to distinguish between hypertensive and traumatic hemorrhage.…”

“…[1][2][3] The incidence of TBGH is between 2.4 and 3% after a closed head injury. [1][2][3] Autopsy studies suggest a far greater incidence rate of 10 to 12%. 1,2 It is classified based on diameter as small (size <2 cm) and large (size >2 cm).…”

Traumatic Basal Ganglia Hematoma

“…1,6,[10][11][12] The exact pathogenesis of TBGH is not clear, but, it has been suggested that the TBGH can occur from acceleration/deceleration forces at the time of injury leading to shear strain of the lenticulostriate or anterior choroidal vessels. 1,4,10,13,14-16 Based on the diameter, TBGH are classified as small (<2 cm) and large hemorrhages (>2 cm).…”