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.