Traumatic basal ganglia hemorrhage: illustrative cases

Abstract

Background: Traumatic basal ganglia hemorrhage (TBGH) is rare. The most common mechanism of injury is road traffic accidents. In this case series, the authors discuss the clinical course of 5 patients with TBGH with different outcomes.

Observations: The internal capsule is the most commonly involved site, which was noted in 3 of the 5 cases reported here. The size of the TBGHs ranged from 1.02 cm to 2.61 cm. All patients had at least 1 additional site of bleeding. One patient had zygomatic, maxillary, and mandibular fractures, while another patient had a mandibular fracture. Two of the 5 patients died. These 2 patients had Glasgow Coma Scale (GCS) scores of 3 and 4, and their pupils were not reactive to light after resuscitation and loading with mannitol.

Lessons: CT findings in TBGHs differ from those in spontaneous hemorrhages in that gray-white matter junction contusions and ventral or dorsolateral brainstem contusions are more commonly observed in the former. Compared with other fractures, mandibular fractures are more commonly associated with TBGH. Conservative treatment is a valid approach for managing patients with TBGH. The overall prognosis of patients with TBGH is poor, and the highest mortality rates are seen in patients with low GCS scores and absent pupillary light reactions. https://thejns.org/doi/10.3171/CASE24625.

Keywords: case series; diffuse axonal injury; head injury; road traffic accident; traumatic basal ganglia hemorrhage.

FIG. 1.

Case 1. A: Head CT scan obtained in a 43-year-old male, showing right basal ganglia posttraumatic hemorrhage (yellow arrow). B: Open basal cisterns (yellow arrow) and extension of basal ganglia hemorrhage (white arrow). C: Zygomatic fracture (yellow arrow) and maxillary sinus fracture (red arrow). D: Mandibular fracture (red arrows). E: CT angiogram showing right basal ganglia hemorrhage (red arrows) and the absence of any vascular malformation.

FIG. 2.

A and B: Case 2. Left basal ganglia bleeding (red arrow) and left temporal resolving contusion with edema (A; white arrow). Resolution of left basal ganglia hemorrhage (red arrow), hypodense change in the left temporal region with decreased mass effect (white arrows) and open basal cisterns (B; yellow arrow). C–E:Case 3. Noncontrast CT scan showing bilateral SAHs extending to the sylvian fissures (white arrows), bilateral intraventricular hemorrhage (red arrows), and deep parenchymal hemorrhage extending to the thalamus (C; yellow arrows). Noncontrast CT scan showing ventral brainstem contusion (D; red arrow). Left frontal gray-white matter junction contusion (E; red arrow).

FIG. 3.

A and B: Case 4. Right basal ganglia hemorrhage (red arrow), intraventricular hemorrhage (yellow arrows), and multiple small contusions (A; white arrows). Noncontrast CT scan showing brainstem contusions (B; red arrows). C and D: Case 5. Noncontrast CT scan showing right basal ganglia hemorrhage (red arrow) and a deep white matter small contusion (C; yellow arrow). Noncontrast CT scan showing multiple areas of contusions (red arrows) and SAHs (D; yellow arrows).

FIG. 4.

Case 5. A: Noncontrast CT scan showing a mandibular fracture (red arrows). B: Noncontrast CT scan showing a ventral brainstem contusion (red arrows) and basilar artery (yellow arrows). C: CT angiogram showing ring-enhancing resolving contusion (red arrow), a small area of hypodensity at the previous basal ganglia hemorrhage site (yellow arrow), and no vascular abnormalities.