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      Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

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          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s10143-023-02044-x.

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2024)
          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
          Article 0 comments Cited 13276 times – based on 0 reviews     Review now
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            Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis.

            Charlotte JJ van Asch, Merel JA Luitse, Gabriel Rinkel … (2010)
            Since the early 1980s, imaging techniques have enabled population-based studies of intracerebral haemorrhage. We aimed to assess the incidence, case fatality, and functional outcome of intracerebral haemorrhage in relation to age, sex, ethnic origin, and time period in studies published since 1980. From PubMed and Embase searches with predefined inclusion criteria, we identified population-based studies published between January, 1980, and November, 2008. We calculated incidence and case fatality. Incidences for multiple studies were pooled in a random-effects binomial meta-analysis. Time trends of case fatality were assessed with weighted linear-regression analysis. 36 eligible studies described 44 time periods (mid-year range 1983-2006). These studies included 8145 patients with intracerebral haemorrhage. Incidence did not decrease between 1980 and 2008. Overall incidence was 24.6 per 100 000 person-years (95% CI 19.7-30.7). Incidence was not significantly lower in women than in men (overall incidence ratio 0.85, 95% CI 0.61-1.18). Using the age group 45-54 years as reference, incidence ratios increased from 0.10 (95% CI 0.06-0.14) for people aged less than 45 years to 9.6 (6.6-13.9) for people older than 85 years. Median case fatality at 1 month was 40.4% (range 13.1-61.0) and did not decrease over time, and was lower in Japan (16.7%, 95% CI 15.0-18.5) than elsewhere (42.3%, 40.9-43.6). Six studies reported functional outcome, with independency rates of between 12% and 39%. Incidence of intracerebral haemorrhage per 100 000 person-years was 24.2 (95% CI 20.9-28.0) in white people, 22.9 (14.8-35.6) in black people, 19.6 (15.7-24.5) in Hispanic people, and 51.8 (38.8-69.3) in Asian people. Incidence of intracerebral haemorrhage increases with age and has not decreased between 1980 and 2006. Case fatality is lower in Japan than elsewhere, increases with age, and has not decreased over time. More data on functional outcome are needed. Netherlands Heart Foundation. Copyright (c) 2010 Elsevier Ltd. All rights reserved.
            Article 0 comments Cited 473 times – based on 0 reviews     Review now
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              Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.

              Martin O'Donnell, Denis Xavier, Lisheng Liu … (2010)
              The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk factors to the burden of stroke, and explore the differences between risk factors for stroke and myocardial infarction. We undertook a standardised case-control study in 22 countries worldwide between March 1, 2007, and April 23, 2010. Cases were patients with acute first stroke (within 5 days of symptoms onset and 72 h of hospital admission). Controls had no history of stroke, and were matched with cases for age and sex. All participants completed a structured questionnaire and a physical examination, and most provided blood and urine samples. We calculated odds ratios (ORs) and population-attributable risks (PARs) for the association of all stroke, ischaemic stroke, and intracerebral haemorrhagic stroke with selected risk factors. In the first 3000 cases (n=2337, 78%, with ischaemic stroke; n=663, 22%, with intracerebral haemorrhagic stroke) and 3000 controls, significant risk factors for all stroke were: history of hypertension (OR 2.64, 99% CI 2.26-3.08; PAR 34.6%, 99% CI 30.4-39.1); current smoking (2.09, 1.75-2.51; 18.9%, 15.3-23.1); waist-to-hip ratio (1.65, 1.36-1.99 for highest vs lowest tertile; 26.5%, 18.8-36.0); diet risk score (1.35, 1.11-1.64 for highest vs lowest tertile; 18.8%, 11.2-29.7); regular physical activity (0.69, 0.53-0.90; 28.5%, 14.5-48.5); diabetes mellitus (1.36, 1.10-1.68; 5.0%, 2.6-9.5); alcohol intake (1.51, 1.18-1.92 for more than 30 drinks per month or binge drinking; 3.8%, 0.9-14.4); psychosocial stress (1.30, 1.06-1.60; 4.6%, 2.1-9.6) and depression (1.35, 1.10-1.66; 5.2%, 2.7-9.8); cardiac causes (2.38, 1.77-3.20; 6.7%, 4.8-9.1); and ratio of apolipoproteins B to A1 (1.89, 1.49-2.40 for highest vs lowest tertile; 24.9%, 15.7-37.1). Collectively, these risk factors accounted for 88.1% (99% CI 82.3-92.2) of the PAR for all stroke. When an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), the combined PAR was 90.3% (85.3-93.7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebral haemorrhagic stroke. Our findings suggest that ten risk factors are associated with 90% of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke. Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Pfizer Cardiovascular Award, Merck, AstraZeneca, and Boehringer Ingelheim. Copyright 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Paolo Palmisciano: paolo.palmisciano94@gmail.com
                Journal
                Journal ID (nlm-ta): Neurosurg Rev
                Journal ID (iso-abbrev): Neurosurg Rev
                Title: Neurosurgical Review
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0344-5607
                ISSN (Electronic): 1437-2320
                Publication date (Electronic): 5 June 2023
                Publication date (Print): 2023
                Volume: 46
                Issue: 1
                Electronic Location Identifier: 135
                Affiliations
                [1 ]GRID grid.410445.0, ISNI 0000 0001 2188 0957, John A. Burns School of Medicine, , University of Hawai’i, ; Honolulu, HI USA
                [2 ]GRID grid.176731.5, ISNI 0000 0001 1547 9964, Department of Neurosurgery, , University of Texas Medical Branch, ; Galveston, TX USA
                [3 ]GRID grid.168010.e, ISNI 0000000419368956, Department of Pathology, Stanford of School of Medicine, , Stanford University Medical Centre, ; Stanford, Palo Alto, CA USA
                [4 ]GRID grid.412689.0, ISNI 0000 0001 0650 7433, Department of Neurosurgery, , University of Pittsburgh Medical Center, ; Pittsburg, PA USA
                [5 ]GRID grid.240145.6, ISNI 0000 0001 2291 4776, Department of Neurosurgery, , The University of Texas M.D. Anderson Cancer Center, ; Houston, TX USA
                [6 ]Department of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario Canada
                [7 ]GRID grid.17635.36, ISNI 0000000419368657, Department of Neurosurgery, , University of Minnesota, ; Minneapolis, MN USA
                [8 ]GRID grid.24827.3b, ISNI 0000 0001 2179 9593, Department of Neurosurgery, , University of Cincinnati, ; 231 Albert Sabin Way, Cincinnati, OH 45229 USA
                [9 ]Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
                [10 ]GRID grid.413340.1, ISNI 0000 0004 1759 8037, Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, ; Catania, Italy
                Article
                Publisher ID: 2044
                DOI: 10.1007/s10143-023-02044-x
                PMC ID: 10240133
                PubMed ID: 37273079
                SO-VID: e86125d1-68f5-4b96-a050-b5ce747c7e91
                Copyright © © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 25 January 2023
                Date revision received : 6 May 2023
                Date accepted : 27 May 2023
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2023

                ScienceOpen disciplines: Surgery
                Keywords: basal ganglia,head trauma,hematoma evacuation,intracerebral hemorrhage,neurointensive care management
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: basal ganglia, head trauma, hematoma evacuation, intracerebral hemorrhage, neurointensive care management

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