Spontaneous Bilateral Basal Ganglia Hemorrhage Due to Severe Hypertension

The basal ganglia, which comprise many subcortical nuclei, constitute an integrated functional unit of the brain. Spontaneous hemorrhage of the basal ganglia is mostly unilateral and secondary to uncontrolled hypertension. Simultaneous bilateral basal ganglia hemorrhage (SBBGH) is very rare. So far, only 40 cases have been documented so far.

Here, we report a 37-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion, and right-sided weakness for 2 days. An urgent non-contrast brain CT performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the basal ganglia. On admission, blood pressure was 220/120. Other vital signs were normal. The patient was admitted to the ICU, IV antihypertensive and antiedema medications were given. After clinical improvement, he was transferred to the neurology ward on the fifth day. After another 5 days in the neurology inpatient ward, the patient clinically improved and was referred to the rehabilitation department.

Due to the rarity of SBBGH, it is particularly interesting to report this remarkable case of a man with simultaneous spontaneous bilateral ganglia hemorrhage secondary to uncontrolled hypertension.