Analysis of Clinicoradiological Profile and Outcome of Traumatic Basal Ganglia Hematoma: A Perspective from Level 1 Trauma Center

Abstract

Introduction: This study was conducted to analyze clinico-radiological profile of traumatic basal ganglia hematoma and identify its prognostic factors.
 Methods and Materials: A prospective study was conducted in the Department of neurosurgery, Trauma center of Banaras Hindu University from September 2016 to March 2020. All patients with traumatic basal ganglia hematoma based on admission CT scan were enrolled and their demographic, clinical, radiological details were maintained till the time of discharge and subsequent follow up. Follow up period was a maximum of two years.
 Results: Out of 41 patients of traumatic basal ganglia hematoma, 68% of cases were males in their third decade. Road traffic accident (76%) was the major etiology. 32% had severe head injury, 78% had hemiparesis at admission and 58% patients required ventilatory support. The mean volume of clot was 15.46 millilitres. Only 24% cases had isolated traumatic basal ganglia hematoma. Advance age, associated intraventricular hemorrhage, ventilator dependence, large hematoma (volume >20 millilitres) and poor Glasgow coma score at admission were significant prognostic factors (p<0.05).
 Conclusion: Traumatic basal ganglia hematoma is a rare entity. Advance age, large volume of hematoma, associated intraventricular hemorrhage, poor Glasgow coma score at admission and ventilator dependence are poor prognostic factors.

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

“…Several prognostic factors are thought to be associated with a poor outcome and include: advanced age; post-resuscitation GCS <7; abnormal pupillary response; abnormal response to pain; ventilator dependence; large hematoma volume (>20 ml); diffuse axonal injury (DAI); association with parenchymal injuries; intraventricular haemorrhage or brain stem haemorrhage; association with coagulation disorder. 9 , 11 , 17 In the case reported here, despite the large size of the basal hematoma, the patient showed good recovery one month after hospital discharge and, two months later, had resumed normal life. Her mild cognitive deficits were probably associated with the DAI.…”

“… 14 In one study of 41 patients with TBGH, 38% had a favourable prognosis and the mortality rate was 10%. 11 By contrast, other studies in smaller numbers of patients have found favourable outcomes in all patients with no mortality. 5 , 7 , 13 …”

“…14 In one study of 41 patients with TBGH, 38% had a favourable prognosis and the mortality rate was 10%. 11 By contrast, other studies in smaller numbers of patients have found favourable outcomes in all patients with no mortality. 5,7,13 Several prognostic factors are thought to be associated with a poor outcome and include: advanced age; post-resuscitation GCS <7; abnormal pupillary response; abnormal response to pain; ventilator dependence; large hematoma volume (>20 ml); diffuse axonal injury (DAI); association with parenchymal injuries; intraventricular haemorrhage or brain stem haemorrhage; association with coagulation disorder.…”

“… 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.…”