An Unusual Combination of Posttraumatic Ipsilateral Basal Ganglia Infarction with Contralateral Hemorrhage: A Rare Case Report and Review of Literature

Abstract

Posttraumatic ipsilateral basal ganglia infarction with contralateral hemorrhage (IBGICH) is an extremely rare neuropathologic entity. Hematomas or infarction of the basal ganglia in head injury have long been recognized but their mechanism has not been revealed clearly. It is presumed to be secondary to rupture and/or vasospasm, followed by thrombosis of the lenticulostriate and/or anterior choroidal artery. This happens by shearing stress as a result of acceleration or deceleration torques. Outcome of traumatic basal ganglia hemorrhage (TBGH) appears favorable unless it is large, associated with coagulation disorders or other intracranial injuries such as diffuse axonal injury, cerebral contusion etc. We present a rare case of a 32-year-old man with traumatic IBGICH (mirror-image). Patient was managed conservatively and discharged with residual paresis and aphasia. Mechanism of trauma, clinical features, management, and most importantly the medicolegal aspect of the TBGH is discussed.