Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 215-216
Isolated traumatic basal ganglia hematoma in children


Department of Neurosurgery, KGMU, Lucknow, Uttar Pradesh, India

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Date of Submission12-Jun-2017
Date of Acceptance20-Jun-2017
Date of Web Publication12-Oct-2017
 

How to cite this article:
Sahoo SK, Vankipuram S, Srivastava C. Isolated traumatic basal ganglia hematoma in children. J Emerg Trauma Shock 2017;10:215-6

How to cite this URL:
Sahoo SK, Vankipuram S, Srivastava C. Isolated traumatic basal ganglia hematoma in children. J Emerg Trauma Shock [serial online] 2017 [cited 2019 Sep 23];10:215-6. Available from: http://www.onlinejets.org/text.asp?2017/10/4/215/216530




Dear Editor,

Basal ganglia (BG) hematoma following head injury in pediatric population is less discussed. Although initially included as a part of diffuse axonal injury, the distinctly different pathogenesis mandates it to be considered as a separate entity. Here, we describe three pediatric cases of isolated BG bleed managed conservatively with good outcome.

A 10-year-old male child presented with fall from tree in unconscious state. On presentation, he was in Glasgow coma scale (GCS) of E1VTM3. The computed tomography (CT) scan showed isolated right-sided BG bleed [Figure 1]a. He was managed conservatively with decongestants and improved gradually. At 6-month follow-up, CT showed complete resolution of hematoma and he improved completely without any focal motor power deficit [Figure 1]b and [Figure 1]C.
Figure 1: (a) Computed tomography scan showing right basal ganglia hematoma. (b) 6-month follow-up computed tomography showing complete resolution of hematoma. (c) Patient at 6-month follow-up

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Another 4-year-old female child with isolated left BG bleed with GCS E1VTM4 and a 13-year-old male child with isolate right BG bleed in GCS E2VTM5 were managed conservatively [Figure 2]a and [Figure 2]b. Both the patients had history of fall from stairs. Although these two patients improved with time, the female child remained aphasic with right-sided hemiparesis of Grade 3/5 at 6-month follow-up.
Figure 2: (a) Computed tomography showing isolated left-sided basal ganglia hematoma. (b) Computed tomography showing right-sided basal ganglia hematoma. Note that the size of hematoma is small without any mass effect

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Isolated BG hematoma following closed head injury is unusual with incidence of <3%.[1] Sudden acceleration or deceleration forces that causes shearing of the lenticulostriate or the anterior choroidal artery will result in BG bleed.[2] Although rare bilateral BG hematoma following trauma has been reported,[3] the eloquent nature of this region is responsible for the severity of symptoms even with a small size hematoma. Moreover, the extent of involvement of the pyramidal or extrapyramidal pathway will determine the residual deficit.

Most of the cases described in literature were managed conservatively. Only those cases with a large hematoma producing mass effect need surgical evacuation. Ultrasound or CT-guided stereotactic aspiration of hematoma is an alternative to open surgery. In our cases, the hematoma sizes were small (<25 ml) and there was no mass effect so managed conservatively.

The mechanism of injury, size of hematoma and associated injuries, and age of patients are the most important prognostic factors.[4] All our three patients had history of fall from height. May be this low-velocity injury caused only rupture of lenticulostriate or the anterior choroidal artery and resulted in isolated BG bleed. However, cases of road traffic accidents with high-velocity injuries may have additional subarachnoid hemorrhage, diffuse axonal injuries, subdural hematoma, or intraventricular hemorrhage that will prolong the hospital stay and affect the overall outcome. Therefore, isolated BG bleed in a setting of closed head injury always has comparatively better outcome than associated multiple head injuries.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kurwale NS, Gupta DK, Mahapatra AK. Outcome of pediatric patients with traumatic basal ganglia hematoma: Analysis of 21 cases. Pediatr Neurosurg 2010;46:267-71.  Back to cited text no. 1
    
2.
Ögrenci A, Eksi MS, Gün B, Koban O. Traumatic basal ganglia hematoma following closed head injuries in children. Childs Nerv Syst 2016;32:1237-43.  Back to cited text no. 2
    
3.
Baek KH, Lee CH, Kim SK, Park H, Kang DH, Hwang SH. A viewpoint on treatment of traumatic bilateral basal ganglia hemorrhage in a child: Case report. Korean J Neurotrauma 2016;12:148-51.  Back to cited text no. 3
    
4.
Bhargava P, Grewal SS, Gupta B, Jain V, Sobti H. Traumatic bilateral basal ganglia hematoma: A report of two cases. Asian J Neurosurg 2012;7:147-50.  Back to cited text no. 4
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Correspondence Address:
Sushanta K Sahoo
Department of Neurosurgery, KGMU, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_65_17

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