Traumatic bilateral basal ganglia hematoma: A report of two cases
A 50-year-old male, farmer by occupation, met with an accident while driving a two wheeler, being hit by a fast moving four wheeler. He lost consciousness immediately. There was no history of any substance abuse, previous illness, or bleeding diathesis. He was not on any regular medication. Patient was non-diabetic and non-hypertensive prior to the accident, he was not on any medication. On examination, his GCS was E1V1M2. Pupils were 4 mm bilaterally, reacting to light. Bilateral limb movements were equal. There were no apparent long bone fractures. Chest compression test was negative. All other parameters were normal. The pulse and blood pressure were normal. Patient was intubated and put on mechanical ventilation. A plain CT scan revealed basal ganglia bleed bilaterally [], involving the temporo parietal regions, 4.2 by 1.8 cm on the right and 3.2 by 3.7 on the left. There was intraventricular hemorrhage also. Basal cisterns were effaced. Subsequent scan after 3 days showed that the hemorrhage was resolving. All blood and radiological parameters including clotting profile were within normal limits. Patient was shifted to neurosurgical ICU and decongestants in the form of frusemide and 20% mannitol were given. Antibiotics and phenytoin sodium was also given. He was continued on ventilatory support, and subsequently tracheostomized on day 6. Nasogastric feed was also started gradually. His motor score gradually improved to withdrawal response (M4) and eye opening to pain (E2) by the 4th day of injury. Supportive care was given. Patient started to localize by day 9, and was referred to district hospital for supportive care.