Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes.
Neurosurg Rev
; 46(1): 135, 2023 Jun 05.
Article
in En
| MEDLINE
| ID: mdl-37273079
ABSTRACT
Bilateral basal ganglia hemorrhages (BBGHs) represent rare accidents, with no clear standard of care currently defined. We reviewed the literature on BBGHs and analyzed the available conservative and surgical strategies. PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies reporting patients with BBGHs. Clinical characteristics, management, and outcomes were analyzed. We included 64 studies comprising 75 patients, 25 (33%) traumatic and 50 (67%) non-traumatic. Traumatic cases affected younger patients (mean age 35 vs. 46 years, p=0.014) and males (84% vs. 71%, p=0.27) and were characterized by higher proportion of normal blood pressures at admission (66% vs. 13%, p=0.0016) compared to non-traumatic cases. Most patients were comatose at admission (56%), with a mean Glasgow Coma Scale (GCS) score of 7 and a higher proportion of comatose patients in the traumatic than in the non-traumatic group (64% vs. 52%, p=0.28). Among the traumatic group, motor vehicle accidents and falls accounted for 79% of cases. In the non-traumatic group, hemorrhage was most associated with hypertensive or ischemic (54%) and chemical (28%) etiologies. Management was predominantly conservative (83%). Outcomes were poor in 56% of patients with mean follow-up of 8 months. Good recovery was significantly higher in the traumatic than in the non-traumatic group (48% vs. 17%, p=0.019). BBGHs are rare occurrences with dismal prognoses. Standard management follows that of current intracerebral hemorrhage guidelines with supportive care and early blood pressure management. Minimally invasive surgery is promising, though substantial evidence is required to outweigh the potentially increased risks of bilateral hematoma evacuation.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Coma
/
Basal Ganglia Hemorrhage
Type of study:
Etiology_studies
/
Guideline
/
Prognostic_studies
/
Systematic_reviews
Limits:
Adult
/
Humans
/
Male
Language:
En
Journal:
Neurosurg Rev
Year:
2023
Document type:
Article
Affiliation country:
Estados Unidos