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[Traumatic hemorrhage in the basal ganglia in the child. Five cases]
Insights
Pediatric basal ganglia hemorrhages from car accidents are linked to severe head impacts. Spotty hematomas indicate a good prognosis, while massive ones suggest a poor outcome.
Area of Science:
- Neuroscience
- Pediatric Traumatology
- Radiology
Background:
- Traumatic brain injuries in children can lead to basal ganglia hemorrhages.
- Understanding the mechanisms and outcomes of these injuries is crucial for pediatric care.
Observation:
- Five children (3 boys, 2 girls, ages 3-13) sustained basal ganglia hemorrhages due to car accidents.
- CT scans revealed spotty hematomas in mild cases with full recovery and massive hematomas in severe cases with poor outcomes.
- Severe cases involved stupor to coma, unsatisfactory surgical recovery, and neurological deficits like hemiparesis and dysarthria.
Findings:
- Pediatric basal ganglia hemorrhages result from severe frontal or occipital impacts.
- Hematoma size correlates with prognosis: spotty (good) versus massive (poor).
- Impact-induced shear strain likely injures basal ganglia vasculature.
Implications:
- CT findings and impact location are key indicators for predicting outcomes in pediatric head trauma.
- This study highlights the severity and varied prognoses of basal ganglia hemorrhages in children.
- Further research into the biomechanics of head impacts and vascular injury is warranted.
Abstract:
Traumatic hemorrhages in the basal ganglia were seen in five children. The CT findings and the characteristics of these injuries were discussed. All of children were injured in car accidents. They ranged in age from 3 to 13 years. The patients comprised 3 boys and 2 girls. On admission, case 1 was conscious and case 2 was in a stupor. Case 1 and 2 were mild cases in which spotty hematomas were seen in the ganglionic region. They recovered fully. Case 3-5 were severe cases in which massive hematomas were seen in the ganglionic region. On admission, their consciousness ranged from stupor to coma. We performed operations on two of them but their recoveries were unsatisfactory. Their results were as follows. One had residual hemiparesis and dysarthria, one experienced tetraparesis and dysarthria and the last went from coma to a vegetative state. Concerning the directions of the impacts, 4 were hit in the frontal region or face and the last one received blows on the occipital region. Skull fractures were seen in two cases. Mandibula and clavicula fractures were seen in the other two cases. Only one child had no fractures. We conclude that pediatric traumatic hemorrhages in the basal ganglia are induced by severe impact on the frontal or occipital regions. The size of hematomas in this injury is spotty or massive. The massive type has a poor prognosis. On the other hand, the spotty type's prognosis is good. We speculate that impact to the head causes a shear strain in the ganglionic region. At that time, vessels in the area are injured.