3. Focal cerebral contusions can be dynamic and expansive, leading to a delayed neurological deterioration. A contusion happens when an injured capillary or blood vessel leaks blood into the surrounding area. Intracerebral hematomas have been, along with subdural hematoma, the most common cause of sport-related lethal brain injuries.20, James W. Bales, ... Richard G. Ellenbogen, in Principles of Neurological Surgery (Fourth Edition), 2018. At the same time, these patients have decreased alertness, decreased coordination, and slowed reaction times. Red arrows indicate some of the numerous microbleeds that are heme-positive and magnetic-field distorting lesions. quadrigeminal cistern subarachnoid hemorrhage, Iatrogenic, e.g. Although not often used merely for the assessment of superficial contusions, MRI is far more sensitive to small contusions, especially on T2* sequences, e.g. Contusions are likely to heal on their own without medical intervention. Contusions may get larger in the hours and days after the injury, causing brain function to deteriorate. Contusions often enlarge during the first week after injury. [2] Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Pathology specimens courtesy of Dr. Juan Troncoso. However, if removing the blood involves removing brain tissue, then brain function may eventually become impaired. [13], Numerous small contusions from broken capillaries that occur in grey matter under the cortex are called multiple petechial hemorrhages or multifocal hemorrhagic contusion. It is now recognized that there is a wide range of severity associated with cerebral contusion. Cerebral contusions are fairly common, found in 8% of all TBI cases14,42 and 13% to 35% of severe injuries.14 Contusions of the brain are often concomitant with SDH. Figure 4. [3] People with cerebral contusion may require intensive care and close monitoring.[3]. Often people are admitted to an intensive care unit. [9] Thus, the tips of the frontal and temporal lobes located near the bony ridges in the skull are areas where contusions frequently occur and are most severe. The vast majority of contusions occurs in the frontal and temporal lobes, although they can occur at almost any site, including the cerebellum and brainstem. "Rapid progression of traumatic bifrontal contusions to transtentorial herniation: A case report", "Mild Traumatic Brain Injury: Toward Understanding Manifestations and Treatment", The Lesion(s) in Traumatic Brain Injury: Implications for Clinical Neuropsychology, Spinal cord injury without radiographic abnormality, https://en.wikipedia.org/w/index.php?title=Cerebral_contusion&oldid=968046385, Creative Commons Attribution-ShareAlike License, CT scan showing cerebral contusions, hemorrhage within the hemispheres, subdural hematoma on the left, and skull fractures, This page was last edited on 16 July 2020, at 22:05. It may occur as a result of nonaccidental trauma. The distal portion of the axon undergoes Wallerian degeneration. Figure 21.4. They may also have vomiting, seizures, or impaired balance or coordination. In contrast to brain contusions, primary traumatic axonal injury (DAI) is the result of inertial loading of axons (impulse, not contact, loading) that occurs very rapidly, usually as a result of rotational acceleration of the head in the course of motor vehicle crashes and high-impact falls. CBV is reduced in proportion to cerebral blood flow (CBF) reduction, following a severe TBI. Cerebral... HEAD TRAUMA. Contusions and lacerations can cause bleeding or swelling in the brain. This preparation of a YFP transgenic mouse exposed to impact acceleration injury depicts injured axons in the corticospinal tract and exemplifies the range of axonal pathologies seen in diffuse axonal injury: in (A), panels 1 and 2 illustrate retraction balls, one of them (1) in the course of what appears to be an intact proximal axon segment and the other (2) right next to the cell body. In the case of diffuse axonal injury, the impulse of rotational acceleration causes ultra-rapid deformation of brain tissue that tends to preferentially damage the white matter with forceful shearing and stretching (left top). Contusions occur primarily in the cortical tissue, especially under the site of impact or in areas of the brain located near sharp ridges on the inside of the skull. Castillo M. Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals. J Neurosurg Sci. Subarachnoid bleeding in the adjacent leptomeninges always accompanies contusion. Biphasing opening of the BBB, following head trauma and a possible second wave of secondary brain damage, was confirmed. 1996 Nov;85(5):871-6. doi: 10.3171/jns.1996.85.5.0871. Hence on follow-up CT scans in the first couple of days after trauma, one may detect the increase in number and size of the lesions but the patient may not show any clinical deterioration. This site complies with the HONcode standard for trustworthy health information: verify here. Therefore, DAI is one of the commonest TBI-associated pathologies and deserves a closer look. [15], Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Most contusions occur in the frontal and temporal lobes, although they can occur at almost any site, including the cerebellum and brainstem. In surviving patients, contusions undergo resorption of the necrotic tissues resulting in cavitated areas with surrounding gliosis and hemosiderin staining of the adjacent leptomeninges. In center coup injuries, the brain is injured on the opposite side where the impact has occurred, whereas in coup injuries, that side of the brain is directly affected. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Table 6. Unable to process the form. Kevin M. Guskiewicz, in Clinical Sports Medicine, 2006, A cerebral contusion is a heterogeneous zone of brain damage that consists of hemorrhage, cerebral infarction, necrosis, and edema. We do not control or have responsibility for the content of any third-party site. These remote contusions are often referred to as plaque jaune or yellow plaque. The injury can cau… A more severe injury causes swelling within the brain, damaging brain tissue further. Sensitivity to detect intracerebral hemorrhage on CT scans is virtually 100%. Most contusions represent the brain coming to a sudden stop against the inner surface of the skull (contrecoup) accentuated by the natural contours of the skull (see below). All of these add up to an increased likelihood of head trauma resulting in a hemorrhagic stroke, either subarachnoid or intraparenchymal, with alcoholic intoxication (Dowling and Curry, 1988). In head--injured patients, the rise in intracranial pressure (ICP), subsequent to uncontrollable swelling, is the only and the most frequent cause of death.
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