Basal ganglia hemorrhage

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Basal ganglia hemorrhage

Epidemiology

Basal ganglia hemorrhage is a common form of intracerebral hemorrhage.

Classification

Spontaneous basal ganglia hemorrhage.

Traumatic basal ganglia hematomas (TBGHs) are uncommon events in patients with closed head injuries.

Putaminal hemorrhage.

Bilateral basal ganglia hemorrhage.

Mechanism

Rzepliński et al. injected 40 anatomic specimens of the basal ganglia with a contrast medium, scanned them with a micro-computed tomography scanner, and analyzed the results of radiological studies, and direct and histological examinations.

In 9 cases, micro-computed tomography and histological examinations revealed contrast medium extravasations mimicking intracerebral hematomas. The artificial hematomas spread both proximally and distally along the ruptured perforator and its branches in the perivascular spaces and detached the branches from the adjacent neural tissue leading to the destruction of the tissue and secondary extravasations. Moreover, some contrast extravasations skipped to the perivascular spaces of unruptured perforators, created further extravasation sites, and aggravated the expansion of the artificial hematoma. There was no subarachnoid extension of any artificial hematoma.

They postulate that forming basal ganglia intracerebral hematoma spread initially in the perivascular space, detaches the branches from the neural tissue, and causes secondary bleeding. It can also skip to the perivascular space of a nearby perforator. The proposed mechanism of hematoma initiation and formation explains the extent of damage to the neural tissue, variability of growth in time and space, creation of secondary bleeding sites, and limited usefulness of surgical interventions. The model is reproducible, the extent of the artificial hematoma can be easily controlled, the rupture sites of the perforating arteries can be determined, and the preparation of the model does not require specialized, expensive equipment apart from the micro-computed tomography scanner 1).

Scales

ICH score

Clinical features

Weakness may be the initial symptom with a basal ganglia hemorrhage

Diagnosis

Basal ganglia hemorrhage diagnosis.

Treatment

see Basal ganglia hemorrhage treatment.

Case series

see Basal ganglia hemorrhage case series.

1)

Rzepliński R, Sługocki M, Tarka S, Tomaszewski M, Kucewicz M, Karczewski K, Krajewski P, Małachowski J, Ciszek B. Mechanism of Spontaneous Intracerebral Hemorrhage Formation: An Anatomical Specimens-Based Study. Stroke. 2022 Sep 8:101161STROKEAHA122040143. doi: 10.1161/STROKEAHA.122.040143. Epub ahead of print. PMID: 36073367.

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