RESUMO
Introduction Basal ganglia traumatic hematoma (BGTH) is rare, occurring in 3% of closed traumatic brain injuries, and it is associated with a poor prognosis. In the present paper, the authors present a series of 16 BGTH cases, describing their causes, treatment, and results. Patients and Methods Thisis a retrospective study of 16 patients diagnosed with BGTH, associated with a literature review in the PubMed, ScienceDirect, and Google Scholar databases, using the terms craniocerebral trauma AND basal ganglia and basal ganglia AND hematoma AND trauma. Articles published in the period from 1986 to 2019 were selected, resulting in a total of 19 articles that met the inclusion criteria taking into account their citations and their respective impacts. Results Sixteen patients were studied. They were all male, with an average age of 21 years and 5 months. The main cause of BGTH was traffic accident (12). The mean score in the Glasgow coma scale at admission was 8. All patients underwent a computed tomography (CT) scan of the skull. The putamen was the most affected structure (5). Thirteen patients underwent conservative treatment, and three drained the associated intracranial hematoma. Nine patients died, and seven, and four had neurological sequel. Conclusions The neurosurgeon's knowledge of GBTH, including diagnosis and clinical surgical management, is extremely important, as this type of lesion is associated with a poor prognosis.
Introdução O hematoma traumático dos gânglios da base (HTGB) é raro, ocorrendo em 3% dos traumatismos cranioencefálicos fechados, estando associado a mau prognóstico. Neste artigo, os autores apresentam uma série de 16 casos de HTGB, descrevendo suas causas, tratamento e resultados. Pacientes e métodos Estudo retrospectivo de 16 pacientes com diagnóstico de HTGB, associado a uma revisão de literatura nas bases de dados PubMed, ScienceDirect e Google Scholar, utilizando os termos: "Craniocerebral Trauma" AND "Basal Ganglia" and "Basal Ganglia"AND "Hematoma"AND "Trauma." Foram selecionados artigos com período de 1986 a 2019, resultando em um total de 19 artigos que atenderam aos critérios de inclusão levando em consideração suas citações e seus respectivos impactos. Resultados Dos 16 pacientes foram estudados, todos do sexo masculino e com idade média de 21 anos e 5 meses. A principal causa de HTGB foi acidente de trânsito (12). A pontuação média na escala de coma de Glasgow na admissão foi de 8. Todos foram submetidos a uma tomografia computadorizada do crânio. Putamen foi o mais afetado (5). Treze pacientes foram submetidos a tratamento conservador e três apresentaram o hematoma intracraniano associado. Nove pacientes morreram e sete, e quatro tiveram sequelas neurológicas. Conclusões O conhecimento dos neurocirurgiões sobre HTGB, diagnóstico e manejo clínico cirúrgico é de extrema importância, pois está associado a um mau prognóstico.
RESUMO
The present literature review aims to present the physiology of paroxysmal sympathetic hyperactivity (PSH) as well as its clinical course, conceptualizing them, and establishing its diagnosis and treatment. Paroxysmal sympathetic hyperactivity is a rare syndrome, which often presents after an acute traumatic brain injury. Characterized by a hyperactivity of the sympathetic nervous system, when diagnosed in its pure form, its symptomatologic presentation is through tachycardia, tachypnea, hyperthermia, hypertension, dystonia, and sialorrhea. The treatment of PSH is basically pharmacological, using central nervous system suppressors; however, the nonmedication approach is closely associated with a reduction in external stimuli, such as visual and auditory stimuli. Mismanagement can lead to the development of serious cardiovascular and diencephalic complications, and the need for neurosurgeons and neurointensivists to know about PSH is evident in order to provide a fast and accurate treatment of this syndrome.