TRAUMATIC BASAL GANGLIA HEMATOMA: IMAGING PATTERNS, TREATMENT OUTCOMES, AND SUPERIOR RECOVERY COMPARED TO SPONTANEOUS BASAL GANGLIA BLEED - SJMCH EXPERIENCE

Abstract

Background: Traumatic basal ganglia hematoma (TBGH) is a rare but distinct deep parenchymal injury occurring in 2–3% of closed head injuries, predominantly affecting young males following high-velocity road traffic accidents. Unlike spontaneous hypertensive basal ganglia hemorrhage, TBGH arises from shear-induced tearing of perforating vessels (lenticulostriate and anterior choroidal artery branches) during acceleration-deceleration forces, producing smaller, multifocal lesions (<2.5 cm diameter). Characteristic associated findings include gray-white matter junction contusions (universal), intraventricular/subarachnoid hemorrhage (60%), brainstem contusions (70%), and skull fractures (50%, often mandibular/zygomatic). Methods: A 10-patient case series from SJMCH Neurosurgery was reviewed, integrating pathophysiology, imaging hallmarks, and management principles. Patients were managed per traumatic brain injury (TBI) protocols—emphasizing airway stabilization, ICP monitoring, osmotherapy, and serial CT—rather than spontaneous intracerebral hemorrhage algorithms. Functional outcomes were assessed using RAS scoring at 3 months. Results: All patients were male with a mean age of 38.7 years. Lesions were right-sided in 60%, with a mean diameter of 1.8 cm (range 1.09–2.9 cm). Epicenters included the internal capsule (40%) and lenticular nucleus (30%), with involvement also of the thalamus, external capsule, and putamen. Eighty percent were managed conservatively and decompressivecraniectomy was performed in select cases with significant mass effect. Three-month RAS scoring demonstrated superior functional recovery compared to historical spontaneous bleed outcomes (mortality 40–50%, persistent hemiparesis). Conclusion: TBGH differs critically from hypertensive hemorrhage by demographics (young, non-hypertensive patients), radiological features (shear stigmata versus solitary clots >3 cm), and prognosis (neuroplasticity in TBI favors recovery in the absence of vascular risk factors). Early recognition and management within a neurotrauma framework enables optimistic outcomes at specialized centers.