Bilateral putaminal haemorrhages – unearthing a myth, lessons learnt

Abstract

Primary multiple spontaneous intracerebral haemorrhages (MSICHs) are a cryptic entity that is very less understood since they are sparsely encountered in clinical practice. MSICH has been deciphered and defined as 'two discrete primary intracerebral haemorrhage occurring simultaneously or within 24 h since the first identified intracerebral haemorrhage. Primary MSICH is sporadic and has a reported incidence varying from 0.75% to 3% of all spontaneous intracerebral haemorrhage; however, the trigger for such bleeds is yet to be ascertained. We present our clinical experience with six cases of MSICHs. A retrospective analysis of data from the Medical Records Department of Kasturba Medical College, Manipal (KMC, Manipal), spanning from 2016 to 2017 and collecting the data of all the patients with the diagnosis of bilateral putaminal haemorrhages who have been treated/operated in KMC, Manipal. SPSS software was used to analyse the data and determines the correlation between the variables. Simultaneous bilateral basal ganglionic bleeds are rare but carry a grave prognosis. The exact pathophysiology is unknown but is probably related to long-standing hypertension. The treatment essentially involves primary prevention with strict control of hypertension and minimising the risk factors. SICH are very rare forms of intracranial bleeds and are often associated with high morbidity and mortality. Often seen in the basal ganglia or thalamus, the mechanism and predisposing factors still remain elusive. The varied clinical presentation and uncertainty in ideal treatment still leave a lot to subjective protocols of individual surgeons. The jury is still out in this matter.