Traumatic bilateral basal ganglia hematoma: A report of two cases
A 25 year old male, farmer by occupation, met with an accident when he was riding a bicycle and was hit by a fast moving truck. He was brought to the emergency in an unconscious state. Left ear bleed was present. There was no history of nose bleed, seizure, or cerebrospinal fluid leak. There was no history of significant illness, substance abuse, or any history suggestive of any bleeding disorder. Patient was a non-diabetic non-hypertensive. Prior to the accident, he was not on any medication. On examination, his Glasgow Coma Scale (GCS) was E1V1M2 Pupils were 2 mm bilaterally, reacting to light. There was right hemiplegia. Right sided pneumothorax was present for which a tube thoracostomy was done. The pulse and blood pressure was normal. Patient was intubated and put on mechanical ventilation. A plain Computerized Tomogram (CT) showed Intracerebral bleed [] in the basal ganglia involving the corona radiata on the right (approximately 18 mm by 11 mm) and left (approximately 30 mm by 21 mm). There was small amount of blood in the right frontoparietal cortex. Sulcal spaces and basal cisterns were effaced. There was fracture of left temporal bone [] and blood in the left mastoid, middle ear, sphenoid and bilateral ethmoidal sinus. All blood parameters and radiology 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 5. Nasogastric feed was also started gradually. A Gadolinium enhanced magnetic resonance imaging study (MRI) done on day 7 of injury did not reveal any vascular lesion [Figure –]. The hematomas were resolving and edema was decreasing. Non-contrast CT done after 35 days showed complete resolution of the hematoma []. His motor score gradually improved to withdrawal response (M4) and eye opening was spontaneous (E4) by the 8th day of injury. Phenytoin was continued. The chest tube was removed after confirming lung expansion on chest radiograph. Supportive care was given and patient was weaned off the ventilator. He had spontaneous eye opening and was maintaining eye contact. On follow-up, patient had regained consciousness and obeyed verbal commands. He still had dysphasia with right spastic hemi paresis.