Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

Abstract

Bilateral basal ganglia hemorrhages (BBGHs) represent rare accidents, with no clear standard of care currently defined. We reviewed the literature on BBGHs and analyzed the available conservative and surgical strategies. PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies reporting patients with BBGHs. Clinical characteristics, management, and outcomes were analyzed. We included 64 studies comprising 75 patients, 25 (33%) traumatic and 50 (67%) non-traumatic. Traumatic cases affected younger patients (mean age 35 vs. 46 years, p =0.014) and males (84% vs. 71%, p =0.27) and were characterized by higher proportion of normal blood pressures at admission (66% vs. 13%, p =0.0016) compared to non-traumatic cases. Most patients were comatose at admission (56%), with a mean Glasgow Coma Scale (GCS) score of 7 and a higher proportion of comatose patients in the traumatic than in the non-traumatic group (64% vs. 52%, p =0.28). Among the traumatic group, motor vehicle accidents and falls accounted for 79% of cases. In the non-traumatic group, hemorrhage was most associated with hypertensive or ischemic (54%) and chemical (28%) etiologies. Management was predominantly conservative (83%). Outcomes were poor in 56% of patients with mean follow-up of 8 months. Good recovery was significantly higher in the traumatic than in the non-traumatic group (48% vs. 17%, p =0.019). BBGHs are rare occurrences with dismal prognoses. Standard management follows that of current intracerebral hemorrhage guidelines with supportive care and early blood pressure management. Minimally invasive surgery is promising, though substantial evidence is required to outweigh the potentially increased risks of bilateral hematoma evacuation. Supplementary Information The online version contains supplementary material available at 10.1007/s10143-023-02044-x.

Comparison of therapeutic effects of endoscopic assisted different surgical approaches in hypertensive intracerebral hemorrhage: A retrospective cohort study

“…[5] Brain edema and space-occupying effects can further increase blood pressure, create a vicious cycle, and affect the disease prognosis. [4][5][6] Therefore, early elimination of the hematoma-occupying effect and elimination of secondary lesions of hematoma are of great significance.…”

“…[ 3 ] After the onset of HICH, the hematoma rapidly expands and damages brain tissue and local nerve cells, leading to brain dysfunction. [ 3 , 4 ] And the expansion of hematoma can compress the surrounding brain tissue, affect vascular circulation, cause hypoxia and ischemia of the brain tissue, and lead to cerebral edema. [ 5 ] Brain edema and space-occupying effects can further increase blood pressure, create a vicious cycle, and affect the disease prognosis.…”