Basal ganglia hematomas in severely head injured patients: clinicoradiological analysis of 37 cases

Object. The authors analyzed the clinicoradiological presentation. of traum atic basal ganglia hematomas (TBGHs) in severely head injured (SHI) patient s. Methods. The records of 37 patients (28 male and nine female patients with a mean age of 28 years) in whom computerized tomography (CT) scans revealed TBGHs 2 ml or more in volume were retrospectively reviewed. These cases re presented 2.4% of the total series of 1526 SHI patients admitted to the aut hors' institution between 1979 and 1998. Thirty-five patients (94%) were in volved in traffic accidents and only two exhibited a period of lucidity. As sociated extracranial injuries were seen in 21 patients (57%) and coagulati on disorders in 32 (86%). Skull fracture was present in 10 (43%) of the 23 patients in whom skull x-ray films were obtained. Computerized tomography f indings indicated diffuse axonal injury in 27 patients (73%). intraventricu lar hemorrhage in 22 patients (59%), and subarachnoid hemorrhage in 16 pati ents (43%). In all but two patients, the TBGHs were visible on the initial CT scan, and in 28 cases (76%) these hematomas were contralateral to the si de of impact. Hematoma enlargement over the first few posttraumatic days wa s noted in 65% of the patients in whom control CT scans had been obtained ( 22 of 34 patients). Four patients (11%) underwent surgery to remove their T BGHs. Final outcomes were poor: 22 patients (59%) died, two (5%) became veg etative, seven (19%) experienced severe disabilities, and only six patients (16%) made a favorable recovery. Conclusions. Traumatic basal ganglia hematomas are dynamic lesions that ten d to enlarge during the acute posttraumatic period. The overall prognosis i n this series was poor. Patients in whom the volume of the hematoma was lar ger than 25 ml and those in whom hematoma volume enlargement or raised intr acranial pressure occurred had the worst outcomes, perhaps indicating the n eed for a more aggressive surgical treatment.