Basal ganglia hemorrhage is one of the more common types of deep intracerebral hemorrhages. It may occur on the grounds of pre-existing hypertension, or in the setting of trauma. In addition to the classical symptoms - nausea, vomiting, and headaches, cognitive impairment and movement disorders are also seen. A thorough clinical observation and imaging studies, primarily computed tomography, are used to make the diagnosis.
Together with the internal capsule, the basal ganglia are one of the most frequent sites of intracerebral hemorrhage, comprising between 35%-70% of all cases . Basal ganglia hemorrhage predominantly develops in the presence of several risk factors, most important being long-standing hypertension (vascular malformations, tumors, other cardiovascular diseases or an aneurysm are additional predisposing risks), whereas traumatic, although much rarer, is a less common but still important cause    . The clinical presentation of hemorrhagic lesions in the brain encompasses several nonspecific features - nausea, headache, vomiting and altered mental state, but several authors have described specific focal neurological deficits in the setting of basal ganglia hemorrhage    . Cognitive impairment, altered perception and emotional processing, and even depression have been reported in lesions of the basal ganglia, whereas a range of movement disorders are described in these patients as well   . Dystonia, asterixis, chorea and hypokinesia are reported after basal ganglia stroke, but restless leg syndrome (RLG), distinguished by a rather unpleasant sensation in the lower extremity, is particularly associated with basal ganglia hemorrhage  . It must be pointed out that trauma may often lead to injury of other brain areas (particularly in the setting of bilateral basal ganglia hemorrhage)  , meaning that a range of other neurological manifestations can be present, depending on the site of injury.
The diagnosis of all intracerebral hemorrhages must be as soon as possible. For this reason, physicians must promptly obtain a detailed patient history and conduct a complete physical examination. The appearance of symptoms, their features, the events that preceded their onset (to determine whether the etiology was traumatic or not), as well as assessment of risk factors (hypertension, cigarette smoking, alcohol abuse, the presence of additional comorbidities, eg. kidney or liver disease, malignancy, but also diabetes mellitus), and a history of similar events should be a part of the patient history  . Recent use of anticoagulant, antithrombotic or other known drugs that disrupt the homeostasis of the vascular system is also vital in identifying the possible pathogenesis , while a complete physical examination, with an emphasis on neurological evaluation, is crucial for determining the site of the lesion. Laboratory testing should be immediately employed, including a complete blood count (CBC), a full coagulation panel, serum electrolytes and renal function . The gold standard for the diagnosis of all intracranial hemorrhages, however, are imaging studies, and computed tomography (CT), widely used as the initial study, is regarded as the optimal procedure, primarily because hemorrhage is evident almost instantaneously after its occurrence  . Magnetic resonance imaging (MRI) is an effective procedure as well and is even superior in terms of identification of the underlying pathology (eg. malignancy)  .