摘要
AIM： To retrospectively analyze the pathogenesis, clinical characteristics, treatment and prognostic characteristics in patients with traumatic basal ganglia hematomas （TBGH）. METHODS： A retrospective analysis of the clinical data was performed in 40 patients with TBGH who were selected from 1 250 patients with closed brain injury, who admitted to the Department of Neurosurgery of Shangqiu First People＇s Hospital from January 1990 to January 2004. The pathogenesis, clinical characteristics and signs, results of radiological examination, treatment and prognostic characteristics were analyzed. The patients all had definite history of brain injury, manifested by neurological functional disturbance to different extent after brain injury, and basal ganglia hemorrhage was identified by CT after brain injury, and hemorrhagic volume were more than or equal to 2 mL. Totally 34 males and 6 females were enrolled, aged 16-72 years and 28 cases of them were younger than 40 years old. The prognosis of the patients was evaluated with Glasgow outcome scale （GOS） at 6 months after injury, and GOS scoring standard was 1-5 points （1 for dead; 2 for vegetative survival, long-term coma, manifestations of decorticate rigidity or decerebrate rigidity; 3 for severely disabled, should be look after by others; 4 for moderately disabled, be able in self-care; 5 for good recovery, adults can work and study）. RESULTS： The enrolled cases accounted for 3.20% of the 1250 patients with closed brain injury admitted at the same period. ① The causes of injury included traffic accident in 36 cases, fall in 2 cases, and assault in 2 cases. ②At admission, the Glasgow coma scale （GCS） scores were as follow： 13-15 scores （mild） in 10 cases, 9-12 scores （moderate） in 20 cases, and 3-8 scores （severe） in 10 cases. Hemiplegia presented in 37 cases, aphasia in 20 cases, conscious disturbance in 10 cases, unilateral mydriasis in 6 cases, and decerebrate rigidity in 2 cases. ③ TBGH was detected by CT within 30 minutes to 24 hours after injury in 37 cases, and delayed TBGH was diagnosed by serial CT reexamination at 24 to 48 hours after injury in 3 cases. Apart from the TBGH, signs of diffuse axonal injury （DAI） were observed in 22 cases and the criterion of CT diagnosis was that apart from TBGH, small hemorrhagic loci were found in the deep white matter of the hemisphere, corpus callosum, dorsolateral quadrants of the midbrain and the upper pons, internal capsule, basal ganglia area, intraventricle, and cerebellum, etc., but there was no obvious mass effect （clinically manifested by conscious disturbance immediately after brain injury, and primary coma lasted for longer than 6 hours）. Secondary intraventricular hemorrhage occurred in 19 cases, acute subdural hematoma in 3 cases, acute epidural hematoma in 1 case, cerebral contusion in 7 cases, and diffuse cerebral swelling in 3 cases. TBGH located at contralateral to the side of impact in 29 cases. The volume of TBGH was 3-9 mL in 8 cases, 10-19 mL in 10 cases, 20-29 mL in 12 cases, and more than 30 mL in 9 cases. ④Ten patients underwent surgical treatment, including TBGH were evacuated by craniotomy in 7 cases, drained by drilling hole in 2 cases, and hematoma drainage combined with extraventricular drainage in 1 case. 30 patients received conservative treatment, including hyperbaric oxygen treatment in 22 cases. ⑤At 6 months after injury, good recovery obtained in 10 cases （25%）, moderately disabled in 17 cases （42.5%）, severely disabled in 2 cases （5%） and dead in 11 cases （27.5%） respectively. CONCLUSION： In our study, the proportion of TBGH in closed brain injury was 3.2%, and it had a higher incidence of disability. Most of the patients were young people and injured in traffic accident, and TBGH mostly oc- curred at contralateral to the side of impact. The patients suffered from hemiplegia and long-term coma, incidence rate of diffuse axonal injury was higher, but conscious disturbance was milder. Conservative treatment was mainly applied in our study. CT scan can not only establish the position, volume of TBGH, but also establish if it combines with other intracranial injury, and it is helpful to detect delayed TBGH.
AIM： To retrospectively analyze the pathogenesis, clinical characteristics, treatment and prognostic characteristics in patients with traumatic basal ganglia hematomas （TBGH）. METHODS： A retrospective analysis of the clinical data was performed in 40 patients with TBGH who were selected from 1 250 patients with closed brain injury, who admitted to the Department of Neurosurgery of Shangqiu First People＇s Hospital from January 1990 to January 2004. The pathogenesis, clinical characteristics and signs, results of radiological examination, treatment and prognostic characteristics were analyzed. The patients all had definite history of brain injury, manifested by neurological functional disturbance to different extent after brain injury, and basal ganglia hemorrhage was identified by CT after brain injury, and hemorrhagic volume were more than or equal to 2 mL. Totally 34 males and 6 females were enrolled, aged 16-72 years and 28 cases of them were younger than 40 years old. The prognosis of the patients was evaluated with Glasgow outcome scale （GOS） at 6 months after injury, and GOS scoring standard was 1-5 points （1 for dead; 2 for vegetative survival, long-term coma, manifestations of decorticate rigidity or decerebrate rigidity; 3 for severely disabled, should be look after by others; 4 for moderately disabled, be able in self-care; 5 for good recovery, adults can work and study）. RESULTS： The enrolled cases accounted for 3.20% of the 1250 patients with closed brain injury admitted at the same period. ① The causes of injury included traffic accident in 36 cases, fall in 2 cases, and assault in 2 cases. ②At admission, the Glasgow coma scale （GCS） scores were as follow： 13-15 scores （mild） in 10 cases, 9-12 scores （moderate） in 20 cases, and 3-8 scores （severe） in 10 cases. Hemiplegia presented in 37 cases, aphasia in 20 cases, conscious disturbance in 10 cases, unilateral mydriasis in 6 cases, and decerebrate rigidity in 2 cases. ③ TBGH was detected by CT within 30 minutes to 24 hours after injury in 37 cases, and delayed TBGH was diagnosed by serial CT reexamination at 24 to 48 hours after injury in 3 cases. Apart from the TBGH, signs of diffuse axonal injury （DAI） were observed in 22 cases and the criterion of CT diagnosis was that apart from TBGH, small hemorrhagic loci were found in the deep white matter of the hemisphere, corpus callosum, dorsolateral quadrants of the midbrain and the upper pons, internal capsule, basal ganglia area, intraventricle, and cerebellum, etc., but there was no obvious mass effect （clinically manifested by conscious disturbance immediately after brain injury, and primary coma lasted for longer than 6 hours）. Secondary intraventricular hemorrhage occurred in 19 cases, acute subdural hematoma in 3 cases, acute epidural hematoma in 1 case, cerebral contusion in 7 cases, and diffuse cerebral swelling in 3 cases. TBGH located at contralateral to the side of impact in 29 cases. The volume of TBGH was 3-9 mL in 8 cases, 10-19 mL in 10 cases, 20-29 mL in 12 cases, and more than 30 mL in 9 cases. ④Ten patients underwent surgical treatment, including TBGH were evacuated by craniotomy in 7 cases, drained by drilling hole in 2 cases, and hematoma drainage combined with extraventricular drainage in 1 case. 30 patients received conservative treatment, including hyperbaric oxygen treatment in 22 cases. ⑤At 6 months after injury, good recovery obtained in 10 cases （25%）, moderately disabled in 17 cases （42.5%）, severely disabled in 2 cases （5%） and dead in 11 cases （27.5%） respectively. CONCLUSION： In our study, the proportion of TBGH in closed brain injury was 3.2%, and it had a higher incidence of disability. Most of the patients were young people and injured in traffic accident, and TBGH mostly oc- curred at contralateral to the side of impact. The patients suffered from hemiplegia and long-term coma, incidence rate of diffuse axonal injury was higher, but conscious disturbance was milder. Conservative treatment was mainly applied in our study. CT scan can not only establish the position, volume of TBGH, but also establish if it combines with other intracranial injury, and it is helpful to detect delayed TBGH.
